Smart Mandibular Repositioning System

ABSTRACT

Systems and methods for detecting an obstructive sleep apnea event are disclosed herein. The systems and methods may use an electrical output generating ionic polymer metal composite sensor attached to a region in an airway passage in an oral cavity. The electrical output may be wirelessly transmitted as a signal for indication of an obstructive sleep apnea event. The signal may be further processed by a smart mandibular repositioning system for treatment of the obstructive sleep apnea event.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 11/613,027, filed on Dec. 19, 2006, which is acontinuation-in-part of U.S. patent application Ser. Nos. 10/946,435,filed on Sep. 21, 2004, and 11/233,493 filed on Sep. 21, 2005, and11/355,927 filed on Feb. 15, 2006, this application is also acontinuation-in-part of U.S. Provisional Application 61/055,405, filedon May 22, 2008; all of which are incorporated by reference herein intheir entireties.

BACKGROUND OF THE INVENTION

Snoring is very common among mammals including humans. Snoring is anoise produced while breathing during sleep due to the vibration of thesoft palate and uvula. Not all snoring is bad, except it bothers the bedpartner or others near the person who is snoring. If the snoring getsworst overtime and goes untreated, it could lead to apnea.

Those with apnea stop breathing in their sleep, often hundreds of timesduring the night. Usually apnea occurs when the throat muscles andtongue relax during sleep and partially block the opening of the airway.When the muscles of the soft palate at the base of the tongue and theuvula relax and sag, the airway becomes blocked, making breathinglabored and noisy and even stopping it altogether. Sleep apnea also canoccur in obese people when an excess amount of tissue in the airwaycauses it to be narrowed.

In a given night, the number of involuntary breathing pauses or “apneicevents” may be as high as 20 to 60 or more per hour. These breathingpauses are almost always accompanied by snoring between apnea episodes.Sleep apnea can also be characterized by choking sensations.

Sleep apnea is diagnosed and treated by primary care physicians,pulmonologists, neurologists, or other physicians with specialtytraining in sleep disorders. Diagnosis of sleep apnea is not simplebecause there can be many different reasons for disturbed sleep.

The specific therapy for sleep apnea is tailored to the individualpatient based on medical history, physical examination, and the resultsof polysomnography. Medications are generally not effective in thetreatment of sleep apnea. Oxygen is sometimes used in patients withcentral apnea caused by heart failure. It is not used to treatobstructive sleep apnea.

Nasal continuous positive airway pressure (CPAP) is the most commontreatment for sleep apnea. In this procedure, the patient wears a maskover the nose during sleep, and pressure from an air blower forces airthrough the nasal passages. The air pressure is adjusted so that it isjust enough to prevent the throat from collapsing during sleep. Thepressure is constant and continuous. Nasal CPAP prevents airway closurewhile in use, but apnea episodes return when CPAP is stopped or it isused improperly. Many variations of CPAP devices are available and allhave the same side effects such as nasal irritation and drying, facialskin irritation, abdominal bloating, mask leaks, sore eyes, andheadaches. Some versions of CPAP vary the pressure to coincide with theperson's breathing pattern, and other CPAPs start with low pressure,slowly increasing it to allow the person to fall asleep before the fullprescribed pressure is applied.

Dental appliances that reposition the lower jaw and the tongue have beenhelpful to some patients with mild to moderate sleep apnea or who snorebut do not have apnea. A dentist or orthodontist is often the one to fitthe patient with such a device.

Some patients with sleep apnea may need surgery. Although severalsurgical procedures are used to increase the size of the airway, none ofthem is completely successful or without risks. More than one proceduremay need to be tried before the patient realizes any benefits. Some ofthe more common procedures include removal of adenoids and tonsils(especially in children), nasal polyps or other growths, or other tissuein the airway and correction of structural deformities. Younger patientsseem to benefit from these surgical procedures more than older patients.

Uvulopalatopharyngoplasty (UPPP) is a procedure used to remove excesstissue at the back of the throat (tonsils, uvula, and part of the softpalate). The success of this technique may range from 30 to 60 percent.The long-term side effects and benefits are not known, and it isdifficult to predict which patients will do well with this procedure.

Laser-assisted uvulopalatoplasty (LAUP) is done to eliminate snoring buthas not been shown to be effective in treating sleep apnea. Thisprocedure involves using a laser device to eliminate tissue in the backof the throat. Like UPPP, LAUP may decrease or eliminate snoring but noteliminate sleep apnea itself. Elimination of snoring, the primarysymptom of sleep apnea, without influencing the condition may carry therisk of delaying the diagnosis and possible treatment of sleep apnea inpatients who elect to have LAUP. To identify possible underlying sleepapnea, sleep studies are usually required before LAUP is performed.

Somnoplasty is a procedure that uses RF to reduce the size of someairway structures such as the uvula and the back of the tongue. Thistechnique helps in reducing snoring and is being investigated as atreatment for apnea.

Tracheostomy is used in persons with severe, life-threatening sleepapnea. In this procedure, a small hole is made in the windpipe and atube is inserted into the opening. This tube stays closed during wakinghours and the person breathes and speaks normally. It is opened forsleep so that air flows directly into the lungs, bypassing any upperairway obstruction. Although this procedure is highly effective, it isan extreme measure that is rarely used.

Patients in whom sleep apnea is due to deformities of the lower jaw maybenefit from surgical reconstruction. Surgical procedures to treatobesity are sometimes recommended for sleep apnea patients who aremorbidly obese. Behavioral changes are an important part of thetreatment program, and in mild cases behavioral therapy may be all thatis needed. Overweight persons can benefit from losing weight. Even a 10percent weight loss can reduce the number of apneic events for mostpatients. Individuals with apnea should avoid the use of alcohol andsleeping pills, which make the airway more likely to collapse duringsleep and prolong the apneic periods. In some patients with mild sleepapnea, breathing pauses occur only when they sleep on their backs. Insuch cases, using pillows and other devices that help them sleep in aside position may be helpful.

Recently, Restore Medical, Inc., Saint Paul, Minn. has developed a newtreatment for snoring and apnea, called the Pillar technique. PillarSystem is a procedure where 2 or 3 small polyester rod devices areplaced in the patient's soft palate. The Pillar System stiffens thepalate, reduces vibration of the tissue, and prevents the possibleairway collapse. Stiff implants in the soft palate, however, couldhinder patient's normal functions like speech, ability to swallow,coughing and sneezing. Protrusion of the modified tissue into the airwayis another long-term concern.

As the current treatments for snoring and/or apnea are not effective andhave side-effects, there is a need for additional treatment options.

BRIEF SUMMARY OF THE INVENTION

Methods and devices for the treatment of airway disorders, such assnoring and/or apnea are disclosed herein. The device described hereincomprises an actuator element. The actuator element is partially orcompletely implanted in an airway passageway wall or adjacent to an airpassageway wall to treat the improper opening and closing of thepassageway. In preferred embodiments, the actuator element is anelectroactive polymer (EAP) element. The actuator element is typicallyinserted into the soft palate and/or sidewalls of the patient's airway.In one embodiment, the EAP element has a low stiffness under normalconditions. The EAP element is energized when the opening of the airpassageway has to be maintained open, such as during sleep. When the EAPelement is energized, the polymer stiffens and tends to deform and thushas the ability to support the weight of the soft palate and sidewallsof the air ways and open the air passageways. When the charge isremoved, the EAP element becomes soft and tends not to interfere withthe patient's normal activities like swallowing and speech. The airwayimplant devices described herein may completely or partially open therelevant air passageways.

One or more implants are placed in the soft palate, sidewalls of theairway, around the trachea, in the tongue, in the uvula, or incombinations thereof. The implant has lead wires (e.g., anode andcathode) attached to the EAP element. In some embodiments, the leadwires are connected to an induction coil. The induction coil istypically implanted in the roof of the mouth. Preferably, the patientwears a retainer type of device before going to bed. The retainer has aninduction coil, a circuit and a battery. When the patient wears theretainer, the induction coil in the retainer is proximal to theinduction coil that is implanted in the roof of the mouth. The energy isthen transmitted through the tissue and to the coil that is in the roofof the mouth. When the EAP element is energized it deforms and/orstiffens to provide support to so as to completely or partially open theairways. In the morning when the patient wakes up, the patient removesthe retainer and places the retainer on a charging unit to recharge thebattery.

A first aspect of the invention is an airway implant device comprisingan electroactive polymer element which is adapted and configured tomodulate the opening of an air passageway. In some embodiments thedevice includes an anode and a cathode connected to the electroactivepolymer element, an inductor, and a controller. The controller can be amicroprocessor which is adapted and configured to sense the opening ofthe air passageway and control the energizing of the electroactivepolymer element. Other embodiments of the device include a non-implantedportion, such as a mouth guard. Preferably, the non-implanted portion isadapted and configured to control the electroactive polymer element. Thenon-implanted portion also typically includes a power source and aninductor. The inductor in the implanted portion is adapted andconfigured to interact with the inductor in the implanted portion of thedevice. The device is preferably adapted and configured for implantationinto a soft palate and/or a lateral pharyngeal wall. In preferredembodiments, the electroactive polymer element comprises an ion-exchangepolymer metal composite. The functioning of the device is preferably byenergizing the electroactive polymer element which then causes acomplete or partial opening of the air passageway. Preferably, thedevice comprises an inductive coupling mechanism adapted to connect theelectroactive polymer element to a power source

Other aspects of the invention are methods of using the devicesdisclosed herein. One embodiment is a method of controlling an openingof an air passageway by implanting an airway implant device comprisingan electroactive polymer element proximal to an air passageway and/or ina wall of an air passageway and controlling the opening of the airpassageway by energizing the electroactive polymer element to completelyor partially open said air passageway. Preferably the control of theopening of the air passageway is in response to feedback from the airpassageway regarding the opening of the air passageway. The airwayimplant device can be implanted in a soft palate and/or a lateralpharyngeal wall. Preferably, the airway implant device is controlled byan inductive coupling mechanism. This method is preferably used to treatairway disorders such as obstructive sleep apnea or snoring.

Another embodiment is a method of treating a disease using an airwayimplant device comprising implanting an airway implant device with anactuator element in the soft palate of a patient and controlling theopening of the air passageway by energizing the actuator element. Theenergizing of the actuator element moves the soft palate to support acollapsed tongue or a tongue that has the tendency to collapse andcompletely or partially opens the air passageway. The actuator elementis preferably a non-magnetic material and even more preferably anelectroactive polymer.

Yet another embodiment is a method of treating a disease using an airwayimplant device comprising implanting an airway implant device with anactuator element in a lateral pharyngeal wall and controlling theopening of the air passageway by energizing the actuator element,wherein the energizing of the actuator element supports the lateralpharyngeal wall and completely or partially opens the air passageway.The actuator element is preferably a non-magnetic material and even morepreferably an electroactive polymer.

In one aspect of the invention the airway implant device furthercomprises a sensor element. The sensor element monitors the condition ofthe airway. Preferably, this monitoring of the airway is used to predictthe occurrence of an apneic event or a snoring event. The sensor elementcan be in the same unit as the airway implant or can be in a separateunit. The sensor element can be implanted proximal to or in an airwaywall. The sensor element, in some embodiments, provides feedback basedon the monitoring directly or indirectly to the actuator element. Theactuation of the actuator element in these embodiments is typicallyrelated to the feedback from the sensor element. In some embodiments,the actuator element functions as the sensor element. One embodiment ofthe invention is an airway implant device comprising an actuator elementand a sensor element, wherein the actuator element is adapted andconfigured to modulate an opening of an air passageway and the sensorelement is adapted and configured to monitor a condition of an airway todetermine the likelihood of an apneic event. The condition beingmonitored can include an air passageway gap, air flow pressure, and/orwall tension. The actuator element and the sensor element can be in twoseparate units. Preferably, the sensor element provides feedback tomodulate the opening of the air passageway by the actuator element. Thedevice can further include a microprocessor adapted and configured tocommunicate with the sensor regarding the opening of the air passagewayand controlling an energizing of the actuator element based on thiscommunication with the sensor element. The device can also include anon-implanted portion. In some embodiments, the non-implanted portioncomprises a power source and in other embodiments it comprises amicroprocessor adapted and configured to communicate with the sensorregarding the opening of the air passageway and controlling anenergizing of the actuator element based on this communication with thesensor element. The sensor element can be located proximal to or in thenose, nostril, soft palate, tongue, laryngeal wall, and/or a pharyngealwall. The sensor element can be a non-contact distance sensor, pressuresensor, flow sensor, and/or a wall tension sensor.

Another aspect of the invention is methods of use of the airway implantdevice which include a sensor. One embodiment is a method of treating adisease using an airway implant device comprising implanting an actuatorelement proximal to and/or in a wall of an air passageway, wherein theactuator element is adapted and configured to monitor a condition of theair passageway to determine likelihood of an apneic event and tomodulate an opening of the air passageway based on the monitoring.Another embodiment is a method of treating a disease using an airwayimplant device comprising implanting an actuator element and a sensorelement proximal to and/or in a wall of an air passageway, wherein theactuator element is adapted and configured to modulate an opening of anair passageway and the sensor is adapted and configured to monitor acondition of the air passageway to determine likelihood of an apneicevent. The sensor element can be further adapted and configured toprovide a feedback to the actuator element regarding the condition beingmonitored and the modulation by the actuator element is related to thefeedback. The sensor element can also activate the actuator element, theactivation being related to the monitoring by the sensor element.Diseases suitable for treatment with the devices include obstructivesleep apnea and/or snoring. Yet another embodiment is a method oftreating a disease using an airway implant device comprising implantingan actuator element and a sensor element proximal to and/or in a wall ofan air passageway; the actuator element being adapted and configured tocontrol an opening of an air passageway by energizing the actuatorelement, wherein the energizing of the actuator element moves the softpalate to support a collapsed tongue and completely or partially opensthe air passageway or supports the lateral pharyngeal wall andcompletely or partially opens up the air passageway and the energizingis in response to feedback from the sensor element regarding an openingof the air passageway.

In yet another aspect of the invention the airway implant devicecomprises an actuator element, a first inductor, and a housing whichhouses the first inductor, wherein the actuator element is adapted andconfigured to modulate an opening of an air passageway. The housing canbe made wholly or in part of acrylic, polytetrafluoroethylene (PTFE),polymethylmethacrylate (PMMA), Acrylonitrile Butadiene Styrene (ABS),polyurethane, polycarbonate, cellulose acetate, nylon, and/or athermoplastic or thermosetting material. The housing can be configuredusing an appropriate shape to reduce or eliminate rocking of the implantacross the hard palate ridge. For example, the housing can be cast tocomport to the shape of a patient palate, or cast from an impression ofa patient palate. In another example, the housing can be cast from thepalate of the patient for whom the implant is intended. Other examplesare where the housing is formed to be substantially smooth rounded,concave, convex, or have bumps on its superior side. If there are bumpson the housing superior side, these bumps can be configured such thatwhen implanted in the palate, there is at least one bump on one lateralside of the hard palate ridge, and at least one bump on the otherlateral side of the hard palate ridge. The housing can be substantiallysmooth and rounded on its inferior side surface. In some embodiments theimplant is secured to tissue using at least one of an anchor, suture, oran adhesive. In some embodiments the implant device further comprises anattachment element wherein the attachment element is capable ofattaching to sutures and capable of securing the implant device totissue. In some embodiments, the attachment element is at least one of aT-shape, triangular shape, circular shape, L-shape, and a Z-shape. Inother embodiments, the attachment element is of a geometry allowingattachment of the implant device to tissue, wherein the attachment is atthe anterior end of the implant and secures the position of the implantwithin the implant cavity. In some embodiments, the implant comprises anattachment element that is bioabsorbable. In some embodiments, theimplant attachment element has at least one hole whereby a suture,screw, or tack can pass through the hole and through tissue to fix theimplant device position and secure the attachment element to tissue. Insome embodiments, the implant device comprises an anchor that is curvedand/or configured to allow delivery and removal with minimal tissuedamage. In some embodiments the housing has a roughened surface toincrease friction, and in some embodiments the roughened surface inducesfibrosis. The roughened surface can be created during casting of thehousing, or after the housing is created. In some embodiments, theimplant device is implanted in a palate. In some embodiments the implanthousing is implanted inferior to the hard palate, and the actuatorelement is implanted in the soft palate. In some embodiments theimplanted portion comprises connecting elements comprising a positivecontact and a negative contact wherein the contacts connect the actuatorelement and the inductor and when charged by the inductor, the actuatorelement is energized. In some embodiments, the actuator elementcomprises an electroactive polymer. In some embodiments, the housinghouses the contacts. When the actuator element is energized, it canstiffen in one direction, or it can deflect, thereby opening the airwayin which the device is implanted. In some embodiments, the implantdevice comprises a non-implanted portion. The non-implanted portion, insome embodiments, comprises a retainer comprising a dental retainermaterial. In a preferred embodiment, the non-implanted portion comprisesa non-implantable wearable element. In some embodiments, thenon-implanted portion comprises a power source and a second inductorconnected to the power source. The power source can be charged in manyways. It can be replaceable, rechargeable within the non-implantedportion, removable and rechargeable outside the non-implanted portion,or a combination of the above. In some embodiments, the non-implantedportion power source is rechargeable, wherein the non-implanted portioncomprises ball clamps having two exposed ball portions, said ball clampsconnected to the rechargeable power source, whereby the ball portionscan recharge the power source. In some embodiments, the power source isa rechargeable battery. In some embodiments, the power source is anon-rechargeable battery that can be replaced as needed. In someembodiments, the power source is sealed within the non-implantedportion, wherein the sealing is fluid proof.

In yet another embodiment the invention may include a system to senseobstructive sleep apnea, including an ionic polymer metal composite(IPMC) sensor attached to a region in an airway passage in an oralcavity which generates an electrical output when a change in shape ofthe airway passage in the oral cavity occurs, and a transmitter deviceelectrically coupled to the IPMC sensor and configured to transmit atleast one electronic signal. In some embodiments the IPMC sensorincludes an electro active polymer material. In some embodiments theIPMC sensor is configured as an elongated strip. In some embodiments theIPMC sensor is placed on the soft palate. In some embodiments the IPMCsensor is placed on the soft palate using an adhesive. In someembodiments the IPMC sensor is implanted into the soft palate. In someembodiments the IPMC sensor includes a second elongated strip whichgenerates a second electronic signal. In some embodiments one elongatedstrip is placed about the soft palate and another is placed about theside palate or pharyngeal walls. In some embodiments the elongatedstrips are integral to the transmitter device. In some embodiments thesystem additionally includes a wireless receiver for receiving the atleast one electronic signal, and a control device electronically coupledto the wireless receiver for recording the electronic signal. In someembodiments the control device additionally performs an analysis of theelectronic signal. In some embodiments the system additionally includesa therapy device operatively coupled with a region in the airway passagein the oral cavity which is at least partially controlled by the controldevice. In some embodiments the transmitter device includes translationcircuitry which translates the electrical output into the at least oneelectronic signal. In some embodiments the at least one electronicsignal is a digital signal. In some embodiments the at least oneelectronic signal is an amplified analog signal. In some embodiments thetransmitter device includes a wireless transmitter for wirelesslytransmitting the at least one electronic signal. In some embodiments thewireless transmitter is configured to transmit under the Bluetoothwireless protocol. In some embodiments the transmitter device includes abattery. In some embodiments at least a portion of the transmitterdevice is detachable from the IPMC sensor for recharging the battery. Insome embodiments the IPMC sensor outputs the electrical output inabsence of a power source.

Yet another embodiment of the invention may include a method for sensingobstructive sleep apnea, comprising generating an electrical output froman ionic polymer metal composite (IPMC) sensor attached to a region inan airway passage in an oral cavity, transmitting a signal which isbased on the generated electrical output from the IPMC. In someembodiments the method may additionally include translating thegenerated electrical output into the signal. In some embodiments thesignal is digital. In some embodiments the signal is analog. In someembodiments the method additionally includes analyzing the transmittedsignal. In some embodiments the method additionally includes creating apredictive algorithm based on the transmitted signal. In someembodiments the method additionally includes sending a control signal toan obstructive sleep apnea treatment device based on the analyzedtransmitted signal.

Yet another embodiment of the invention may include a system to treatobstructive sleep apnea, including an ionic polymer metal composite(IPMC) sensor attached to a region in an airway passage in an oralcavity which generates an electrical output when a change in shape ofthe airway passage in the oral cavity occurs, a transmitter deviceelectrically coupled to the IPMC sensor and configured to transmit atleast one electronic signal, and an electronically actuated mandibularrepositioning device (MRD) configured to move a jaw from a firstposition to a second position based on the least one electronic signalto treat the sleep apnea event. In some embodiments IPMC sensor includesan electro active polymer material. In some embodiments IPMC sensor isconfigured as an elongated strip. In some embodiments the MRD includes afixed upper jaw positioner configured to align with a portion of anupper denture, at least one linkage with a first end and a second end,the first end moveably attached to the fixed upper jaw positioner, amoveable jaw positioner configured to align with a portion of a lowerdenture and moveably attached to the second end of linkage, and at leastone jaw actuator attached to at least one of the fixed upper jaw, atleast one linkage, and moveable jaw positioner. In some embodiments theMRD additionally includes a control circuit. In some embodiments the atleast one jaw actuator is controlled by the control circuit. In someembodiments the control circuit is wirelessly coupled to the transmitterdevice. In some embodiments the control circuit includes a timer. Insome embodiments the control circuit includes a motor control. In someembodiments the IPMC sensor is integral with the transmitter device. Insome embodiments the at least one electronic signal is a digital signal.In some embodiments the at least one electronic signal is an analogsignal.

Yet another embodiment of the invention may include a method to treatsleep apnea, including generating at least one electronic signal from anionic polymer metal composite (IPMC) sensor attached to a region in anairway passage in an oral cavity when a change in shape of the airwaypassage in the oral cavity occurs from an obstructive sleep apnea event,analyzing the at least one electronic signal, generating an output basedon the at least one electronic signal, and actuating an electronicallyactuated mandibular repositioning device (MRD) configured to move a jawfrom a first position to a second position based on the output to treatthe sleep apnea event. In some embodiments the method additionallyincludes generating at least one additional electronic signal from asecond ionic polymer metal composite (IPMC) sensor. In some embodimentsthe output is generated in a linear or non-linear or an adaptivefashion. In some embodiments output generation is based on neuralnetwork algorithms. In some embodiments generating includes convertingthe at least one additional electronic signal into a digital signal. Insome embodiments the MRD includes at least one MRD motor, and actuatingthe electronically actuated MRD additionally includes activating the atleast one MRD motor to move the jaw from the first position to a secondposition. In some embodiments the at least one electronic signal isgenerated from an electro active polymer material. In some embodimentsthe method additionally includes reactuating the MRD to move the jawfrom the second position to the first position when the obstructivesleep apnea event has subsided. In some embodiments the MRD includes atleast one MRD motor, and reactuating the MRD includes deactivating theleast one MRD motor.

Yet another embodiment of the invention may include a system to treatobstructive sleep apnea, including an ionic polymer metal composite(IPMC) sensor attached to a region in an airway passage in an oralcavity which generates an electrical output when a change in shape ofthe airway passage in the oral cavity occurs, a transmitter deviceelectrically coupled to the IPMC sensor and configured to wirelesslytransmit at least one electronic signal, a sensor analyzerelectronically coupled to the transmitter device for receiving andanalyzing the at least one electronic signal and generating an outputbased thereon, and a positive airway pressure machine electronicallycoupled to the sensor analyzer for generating an optimum input pressureto treat the sleep apnea event according to the output from the sensoranalyzer. In some embodiments the output of the sensor analyzer isgenerated in a linear, non-linear, or adaptive fashion. In someembodiments the output generation is based on neural network algorithms.In some embodiments the IPMC sensor includes an electro active polymermaterial. In some embodiments the IPMC sensor is configured as anelongated strip. In some embodiments the IPMC sensor is implanted intothe soft palate. In some embodiments the IPMC sensor does not include anexternal power source. In some embodiments the positive airway pressuremachine automatically titrates an amount of pressure delivered to apatient. In some embodiments the positive airway pressure machineincludes a pressure controller. In some embodiments the pressurecontroller is coupled to a pressure sensor which outputs a pressuresignal. In some embodiments the pressure signal is also used to generatethe optimum input pressure.

Yet another embodiment of the invention may include a method to treatobstructive sleep apnea, including generating at least one electronicsignal from an iconic polymer metal composite (IPMC) sensor attached toa region in the in the airway passage in the oral cavity when a changein shape of the mouth or larynx occurs from an obstructive sleep apneaevent, wirelessly transmitting the at least one electronic signal,receiving and analyzing the at least one electronic signal, generatingan output based on the at least one electronic signal, and generating anoptimum input pressure at least partially based on the output for apositive airway pressure machine to treat the obstructive sleep apneaevent. In some embodiments the method additionally includes generatingat least one additional electronic signal from a second ionic polymermetal composite (IPMC) sensor. In some embodiments the output isgenerated in a linear or non-linear or adaptive fashion. In someembodiments the output generation is based on neural network algorithms.In some embodiments the method additionally includes generating apressure signal from a pressure sensor. In some embodiments the pressuresignal is also used to generate the optimum input pressure. In someembodiments the output is the sole input to generate the optimum inputpressure. In some embodiments wirelessly transmitting the at least oneelectronic signal is performed by a transmitter device which is integralwith the IPMC sensor.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates one embodiment of the airway implant device.

FIG. 2 illustrates one embodiment of the airway implant device.

FIG. 3 illustrates one embodiment of the airway implant device.

FIG. 4 illustrates one embodiment of the airway implant device.

FIG. 5 illustrates a circuit diagram of an embodiment of the airwayimplant device.

FIG. 6 illustrates an embodiment of the airway implant device.

FIG. 7 illustrates a sectional view of an embodiment of theelectroactive polymer element.

FIG. 8 illustrates a sectional view of an embodiment of theelectroactive polymer element.

FIG. 9 illustrates an embodiment of the electroactive polymer element.

FIG. 10 illustrates an embodiment of the electroactive polymer element.

FIG. 11 illustrates an embodiment of the electroactive polymer element.

FIG. 12 illustrates an embodiment of the electroactive polymer element.

FIG. 13 illustrates an embodiment of the electroactive polymer element.

FIG. 14 illustrates an embodiment of the electroactive polymer element.

FIG. 15 illustrates an embodiment of the electroactive polymer element.

FIG. 16 illustrates an embodiment of the electroactive polymer element.

FIG. 17 illustrates an embodiment of the electroactive polymer element.

FIG. 18 illustrates an embodiment of the electroactive polymer element.

FIG. 19 illustrates an embodiment of the electroactive polymer element.

FIG. 20 illustrates an embodiment of the implanted portion of the airwayimplant device.

FIG. 21 illustrates an embodiment of the airway implant device.

FIG. 22 illustrates an embodiment of the non-implanted portion in theform of a mouth guard.

FIG. 23 illustrates an embodiment of the non-implanted portion in theform of a mouth guard.

FIG. 24 illustrates an embodiment of the non-implanted portion.

FIG. 25 shows a sagittal section through a head of a subjectillustrating an embodiment of a method for using the airway implantdevice.

FIG. 26 illustrates an anterior view of the mouth with see-through mouthroofs to depict an embodiment of a method for using the airway implantdevice.

FIG. 27 illustrates an anterior view of the mouth with see-through mouthroofs to depict an embodiment of a method for using the airway implantdevice.

FIG. 28 illustrates an anterior view of the mouth with see-through mouthroofs to depict an embodiment of a method for using the airway implantdevice.

FIG. 29 illustrates an anterior view of the mouth with see-through mouthroofs to depict an embodiment of a method for using the airway implantdevice.

FIG. 30 illustrates an embodiment of an inductive coupling systemassociated with the airway implant device.

FIG. 31 illustrates an embodiment of the airway implant device.

FIG. 32 illustrates an embodiment of the airway implant device.

FIG. 33 illustrates an embodiment in which a patient wears thenon-implanted portion of the device on the cheeks.

FIG. 34A-34B illustrates an embodiment of a method of the invention withthe airway implant in the soft palate.

FIG. 35A-35B illustrates an embodiment of a method of the invention withthe airway implants in the soft palate and lateral pharyngeal walls.

FIG. 36A-36B illustrates an embodiment of a method of the invention withthe airway implants in the lateral pharyngeal walls.

FIG. 37 depicts the progression of an apneic event.

FIG. 38 depicts an embodiment of an airway implant device with sensorsin the soft palate and laryngeal wall.

FIG. 39 depicts the functioning of an airway implant device with sensorsin the soft palate and laryngeal wall.

FIG. 40 depicts an embodiment of an airway implant device with a sensorin the laryngeal wall.

FIG. 41 depicts an example of controller suitable for use with an airwayimplant device.

FIG. 42 depicts an embodiment of an airway implant device.

FIG. 43 depicts an embodiment of an airway implant device.

FIGS. 44A, 44B, and 44C illustrate terms used in describing the anatomyof a patient and orientation attributes of the invention.

FIG. 45A illustrates an embodiment of the airway implant device.

FIG. 45B illustrates the airway implant device of FIG. 45A, viewed fromthe anterior side of the implant, looking toward the posterior end,wherein the implant device is implanted in the palate.

FIG. 46A illustrates an embodiment of the airway implant device.

FIG. 46B illustrates the airway implant device of FIG. 46A, viewed fromthe anterior side of the implant, looking toward the posterior end,wherein the implant device is implanted in the palate.

FIG. 47A illustrates an embodiment of the airway implant device with aT-shaped attachment element.

FIG. 47B illustrates an embodiment of the airway implant device with aperforated attachment element.

FIG. 48 illustrates an embodiment of the airway implant device withsaw-blade like directional attachment element.

FIG. 49 illustrates an embodiment of the airway implant device withpower connecting element.

FIG. 50 illustrates an embodiment of the airway implant system with bothan implantable device and a non-implantable wearable element.

FIG. 51A illustrates an isometric view of the wearable element.

FIG. 51B illustrates a bottom view of the wearable element.

FIG. 52 illustrates a cross-sectional view of the airway implant systemin the patient soft palate.

FIG. 53A illustrates a top view of a implantable obstructive sleep apneasensor, according to one embodiment of the invention.

FIG. 53B illustrates a schematic diagram of the implantable obstructivesleep apnea sensor, according to one embodiment of the invention.

FIG. 53C-53H illustrates a top views of an implantable obstructive sleepapnea sensors, according to respective embodiments of the invention.

FIGS. 54A and 54B illustrates frontal views of implantable obstructivesleep apnea sensors in an airway passage of an oral cavity, according torespective embodiments of the invention.

FIG. 55A illustrates a flow diagram of a system for detecting anobstructive sleep apnea event, according to one embodiment of theinvention.

FIG. 55B illustrates a graphical signal output of an implantableobstructive sleep apnea sensor in use, according to one embodiment ofthe invention.

FIG. 56A illustrates a perspective view of a mandibular repositioningdevice, according to one embodiment of the invention.

FIG. 56B illustrates a schematic diagram of a mandibular repositioningdevice in conjunction with a implantable obstructive sleep apnea sensor,according to one embodiment of the invention.

FIG. 56C illustrates a flow diagram of a system for detecting andtreating an obstructive sleep apnea event using a mandibularrepositioning device, according to one embodiment of the invention.

FIG. 57A illustrates a simplified schematic diagram of a positive airwaypressure apparatus for use with a implantable obstructive sleep apneasensor, according to one embodiment of the invention.

FIG. 57B illustrates a flow diagram of a system for detecting andtreating an obstructive sleep apnea event using a positive airwaypressure apparatus, according to one embodiment of the invention.

DETAILED DESCRIPTION Devices and Methods

A first aspect of the invention is a device for the treatment ofdisorders associated with improper airway patency, such as snoring orsleep apnea. The device comprises of an actuator element to adjust theopening of the airway. In a preferred embodiment, the actuator elementcomprises of an electroactive polymer (EAP) element. The electroactivepolymer element in the device assists in maintaining appropriate airwayopening to treat the disorders. Typically, the EAP element providessupport for the walls of an airway, when the walls collapse, and thus,completely or partially opens the airway.

The device functions by maintaining energized and non-energizedconfigurations of the EAP element. In preferred embodiments, duringsleep, the EAP element is energized with electricity to change its shapeand thus modify the opening of the airway. Typically, in thenon-energized configuration the EAP element is soft and in the energizedconfiguration is stiffer. The EAP element of the device can have apre-set non-energized configuration wherein it is substantially similarto the geometry of the patient's airway where the device is implanted.

In some embodiments, the device, in addition to the EAP element,includes an implantable transducer in electrical communication with theEAP element. A conductive lead connects the EAP element and theimplantable transducer to the each other. The device of the presentinvention typically includes a power source in electrical communicationwith the EAP element and/or the implantable transducer, such as abattery or a capacitor. The battery can be disposable or rechargeable.

Preferred embodiments of the invention include a non-implanted portion,such as a mouthpiece, to control the implanted EAP element. Themouthpiece is typically in conductive or inductive communication with animplantable transducer. In one embodiment, the mouthpiece is a dentalretainer with an induction coil and a power source. The dental retainercan further comprise a pulse-width-modulation circuit. When a dentalretainer is used it is preferably custom fit for the individualbiological subject. If the implantable transducer is in inductivecommunication, it will typically include an inductive receiver, such asa coil. The implantable transducer can also include a conductivereceiver, such as a dental filling, a dental implant, an implant in theoral cavity, an implant in the head or neck region. In one embodiment,the device includes a dermal patch with a coil, circuit and powersource, in communication with the implantable transducer. The dermalpatch can also include a pulse-width-modulation circuit.

Another aspect of the invention is a method to modulate air flow throughairway passages. Such modulation is used in the treatment of diseasessuch as snoring and sleep apnea. One method of the invention is a methodfor modulating the airflow in airway passages by implanting in a patienta device comprising an actuator element and controlling the device byenergizing the actuator element. The actuator element preferablycomprises an electroactive polymer element. The actuator element can becontrolled with a mouthpiece inserted into the mouth of the patient. Theenergizing is typically performed with the use of a power source inelectrical communication, either inductive communication or conductivecommunication, with the actuator element. A transducer can be used toenergize the actuator element by placing it in electrical communicationwith the power source. Depending on the condition being treated, theactuator element is placed in different locations such as soft palate,airway sidewall, uvula, pharynx wall, trachea wall, larynx wall, and/ornasal passage wall.

A preferred embodiment of the device of the present invention comprisesan implantable actuator element; an implantable transducer; animplantable lead wire connecting the actuator element and thetransducer; a removable transducer; and a removable power source; andwherein the actuator element comprises an electroactive polymer.

Electroactive polymer is a type of polymer that responds to electricalstimulation by physical deformation, change in tensile properties,and/or change in hardness. There are several types of electroactivepolymers like dielectric electrostrictive polymer, ion exchange polymerand ion exchange polymer metal composite (IPMC). The particular type ofEAP used in the making of the disclosed device can be any of theaforementioned electroactive polymers.

Suitable materials for the electroactive polymer element include, butare not limited to, an ion exchange polymer, an ion exchange polymermetal composite, an ionomer base material. In some embodiments, theelectroactive polymer is perfluorinated polymer such aspolytetrafluoroethylene, polyfluorosulfonic acid, perfluorosulfonate,and polyvinylidene fluoride. Other suitable polymers includepolyethylene, polypropylene, polystyrene, polyaniline,polyacrylonitrile, cellophane, cellulose, regenerated cellulose,cellulose acetate, polysulfone, polyurethane, polyvinyl alcohol,polyvinyl acetate, polyvinyl pyrrolidone. Typically, the electroactivepolymer element includes a biocompatible conductive material such asplatinum, gold, silver, palladium, copper, and/or carbon.

Suitable shapes of the electroactive polymer element include threedimensional shape, substantially rectangular, substantially triangular,substantially round, substantially trapezoidal, a flat strip, a rod, acylindrical tube, an arch with uniform thickness or varying thickness, ashape with slots that are perpendicular to the axis, slots that areparallel to the longitudinal axis, a coil, perforations, and/or slots.

IPMC is a polymer and metal composite that uses an ionomer as the basematerial. Ionomers are types of polymers that allow for ion movementthrough the membrane. There are several ionomers available in the marketand some of the suited ionomers for this application are polyethylene,polystyrene, polytetrafluoroethylene, polyvinylidene fluoride,polyfluorosulfonic acid based membranes like NAFION® (from E. I. Du Pontde Nemours and Company, Wilmington, Del.), polyaniline,polyacrylonitrile, cellulose, cellulose acetates, regenerated cellulose,polysulfone, polyurethane, or combinations thereof. A conductive metal,for example gold, silver, platinum, palladium, copper, carbon, orcombinations thereof, can be deposited on the ionomer to make the IPMC.The IPMC element can be formed into many shapes, for example, a strip,rod, cylindrical tube, rectangular piece, triangular piece, trapezoidalshape, arch shapes, coil shapes, or combinations thereof. The IPMCelement can have perforations or slots cut in them to allow tissue ingrowth.

The electroactive polymer element has, in some embodiments, multiplelayers of the electroactive polymer with or without an insulation layerseparating the layers of the electroactive polymer. Suitable insulationlayers include, but are not limited to, silicone, polyurethane,polyimide, nylon, polyester, polymethylmethacrylate,polyethylmethacrylate, neoprene, styrene butadiene styrene, or polyvinylacetate.

In some embodiments, the actuator element, the entire device, orportions of the airway implant have a coating. The coating isolates thecoated device from the body fluids and/or tissue either physically orelectrically. The device can be coated to minimize tissue growth orpromote tissue growth. Suitable coatings include poly-L-lysine,poly-D-lysine, polyethylene glycol, polypropylene, polyvinyl alcohol,polyvinylidene fluoride, polyvinyl acetate, hyaluronic acid, and/ormethylmethacrylate.

Embodiments of the Device

FIG. 1 illustrates an airway implant system 2 that has a power source 4,a connecting element, such as a wire lead 14, and an actuator element,such as an electroactive polymer element 8. Suitable power sources 4 area power cell, a battery, a capacitor, a substantially infinite bus(e.g., a wall outlet leading to a power generator), a generator (e.g., aportable generator, a solar generator, an internal combustiongenerator), or combinations thereof. The power source 4 typically has apower output of from about 1 mA to about 5 A, for example about 500 mA.

Instead of or in addition to wire lead 14, the connecting element may bean inductive energy transfer system, a conductive energy transfersystem, a chemical energy transfer system, an acoustic or otherwisevibratory energy transfer system, a nerve or nerve pathway, otherbiological tissue, or combinations thereof. The connecting element ismade from one or more conductive materials, such as copper. Theconnecting element is completely or partially insulated and/or protectedby an insulator, for example polytetrafluoroethylene (PTFE). Theinsulator can be biocompatible. The power source 4 is typically inelectrical communication with the actuator element 8 through theconnecting element. The connecting element is attached to an anode 10and a cathode 12 on the power source 4. The connecting elements can bemade from one or more sub-elements.

The actuator element 8 is preferably made from an electroactive polymer.Most preferably, the electroactive polymer is an ion exchange polymermetal composite (IPMC). The IPMC has a base polymer embedded, orotherwise appropriately mixed, with a metal. The IPMC base polymer ispreferably perfluoronated polymer, polytetrafluoroethylene,polyfluorosulfonic acid, perfluorosulfonate, polyvinylidene fluoride,hydrophilic polyvinylidene fluoride, polyethylene, polypropylene,polystyrene, polyaniline, polyacrylonitrile, cellophane, cellulose,regenerated cellulose, cellulose acetate, polysulfone, polyurethane,polyvinyl alcohol, polyvinyl acetate and polyvinyl pyrrolidone, orcombinations thereof. The IPMC metal can be platinum, gold, silver,palladium, copper, carbon, or combinations thereof.

FIG. 2 illustrates that the actuator element 8 can have multipleelements 8 and connecting elements 14 that all connect to a single powersource 4.

FIG. 3 illustrates an airway implant system 2 with multiple powersources 4 and connecting elements 14 that all connect to a singleactuator element 8. The airway implant system 2 can have any number andcombination of actuator elements 8 connected to power sources 4.

FIG. 4 illustrates an embodiment with the connecting element having afirst energy transfer element, for example a first transducer such as afirst receiver, and a second energy transfer element, for example asecond transducer such as a second inductor 16. In this embodiment, thefirst receiver is a first inductor 18. The first inductor 18 istypically positioned close enough to the second inductor 16 to enablesufficient inductive electricity transfer between the second and firstinductors 16 and 18 to energize the actuator element 8. The connectingelement 14 has multiple connecting elements 6.

FIG. 5 illustrates that the airway implant device of the presentinvention can have an implanted portion 20 and a non-implanted portion22. In this embodiment, the implanted portion 20 is a closed circuitwith the first inductor 18 in series with a first capacitor 24 and theactuator element 8. The actuator element 8 is attached to the closedcircuit of the implanted portion 20 by a first contact 26 and a secondcontact 28. In some embodiments, the implanted portion has a resistor(not shown). The non-implanted portion 22 is a closed circuit. Thenon-implanted portion 22 has a second inductor 16 that is in series witha resistor 30, the power source 4, and a second capacitor 32. Thecapacitors, resistors, and, in-part, the inductors are representative ofthe electrical characteristics of the wire of the circuit and notnecessarily representative of specific elements. The implanted portion20 is within tissue and has a tissue surface 33 nearby. Thenon-implanted portion is in insulation material 35. An air interface 37is between the tissue surface 33 and the insulation material 35.

FIG. 6 illustrates an embodiment in which the first energy transferelement of the connecting element 14 is a first conductor 34. The secondenergy transfer element of the connecting element 14 is a secondconductor 36. The first conductor 34 is configured to plug into,receive, or otherwise make secure electrical conductive contact with thesecond conductor 36. The first conductor 34 and/or second conductor 36are plugs, sockets, conductive dental fillings, tooth caps, fake teeth,or any combination thereof.

FIG. 7 illustrates an embodiment in which the actuator element 8 is amulti-layered device. The actuator element 8 has a first EAP layer 38, asecond EAP layer 40, and a third EAP layer 42. The EAP layers 38, 40 and42 are in contact with each other and not separated by an insulator.

FIG. 8 illustrates another embodiment in which the actuator element 8has a first EAP layer 38 separated from a second EAP layer 40 by a firstinsulation layer 44. A second insulation layer 46 separates the secondEAP layer from the third EAP layer 42. A third insulation layer 48separates the third EAP layer from the fourth EAP layer 50. Insulationmaterial is preferably a polymeric material that electrically isolateseach layer. The insulation can be, for example, acrylic polymers,polyimide, polypropylene, polyethylene, silicones, nylons, polyesters,polyurethanes, or combinations thereof. Each EAP layer, 38, 40, 42 and50 can be connected to a lead wire (not shown). All anodes and allcathodes are connected to the power source 4.

FIGS. 9-19 illustrate different suitable shapes for the actuator element8. FIG. 9 illustrates a actuator element 8 with a substantially flatrectangular configuration. The actuator element 8 can have a width fromabout 2 mm to about 5 cm, for example about 1 cm. FIG. 10 illustrates anactuator element 8 with an “S” or zig-zag shape. FIG. 11 illustrates theactuator element 8 with an oval shape. FIG. 12 illustrates a actuatorelement 8 with a substantially flat rectangular shape with slots 52 cutperpendicular to the longitudinal axis of the actuator element 8. Theslots 52 originate near the longitudinal axis of the actuator element 8.The actuator element 8 has legs 54 extending away from the longitudinalaxis. FIG. 13 illustrates an actuator element 8 with slots 52 and legs54 parallel with the longitudinal axis. FIG. 14 illustrates an actuatorelement be configured as a quadrilateral, such as a trapezoid. Theactuator element 8 has chamfered corners, as shown by radius. FIG. 15illustrates an actuator element 8 with apertures 55, holes,perforations, or combinations thereof. FIG. 16 illustrates an actuatorelement 8 with slots 52 and legs 54 extending from a side of theactuator element 8 parallel with the longitudinal axis. FIG. 17illustrates an actuator element 8 with a hollow cylinder, tube, or rod.The actuator element has an inner diameter 56. FIG. 18 illustrates anarched actuator element 8. The arch has a radius of curvature 57 fromabout 1 cm to about 10 cm, for example about 4 cm. The actuator element8 has a uniform thickness. FIG. 19 illustrates an arched actuatorelement 8. The actuator element 8 can have a varying thickness. A firstthickness 58 is equal or greater than a second thickness 60.

FIG. 20 illustrates an embodiment of the implanted portion of an airwayimplant with a coil-type inductor 18 connected by a wire lead 6 to theactuator element 8. In another embodiment, as illustrated in FIG. 21 theimplanted portion has a conductive dental filling 62 in a tooth 64. Thedental filling 62 is previously implanted for reasons related orunrelated to using of the airway implant system. The dental filling 62is electrically connected to the wire lead 6. For example, a portion ofthe wire lead 6 is implanted in the tooth 64, as shown by phantom line.The wire lead 6 is connected to the actuator element 8.

FIG. 22 illustrates an embodiment of the non-implanted portion 22 with amouthpiece, such as a retainer 66. The retainer 66 is preferably customconfigured to fit to the patient's mouth roof, or another part of thepatient's mouth. The second transducer, such as second inductor 16, isintegral with, or attached to, the retainer 66. The second inductor 16is located in the retainer 66 so that during use the second inductor 16is proximal with the first inductor 18. The power source 4, such as acell, is integral with, or attached to, the retainer 66. The powersource 4 is in electrical communication with the second inductor 16. Insome embodiments, the retainer 66 has a pulse-width-modulation circuit.FIG. 23 illustrates that the retainer 66 has one or more tooth sockets68. The tooth sockets 68 are preferably configured to receive teeth thathave dental fillings. The tooth sockets 68 are electrically conductivein areas where they align with dental fillings when in use. The powersource 4 is connected with the tooth sockets 68 via the wire leads 6. Inthe embodiment of FIG. 24, the non-implantable portion 22 has the secondinductor 16 attached to a removably attachable patch 70. The patch 70 isattached to the power source 4. The power source 4 is in contact withthe second inductor 16. This embodiment can be, for example, located onthe cheeks as shown on FIG. 33 or any other suitable location.

Preferably, the airway implant device 2 discussed herein is used incombination with an inductive coupling system 900 such as depicted inFIG. 30. FIG. 30 depicts an inductive coupling system that is suitablefor controlling the airway implant device 2 which includes a connectingelement 906 (which connects the electrical contacts (not shown) to therest of the electrical system), a connector 901, a energy source 322, asensor 903, a timer 904, and a controller 905. The connector 901, energysource 322, sensor 903, a timer 904, and controller 905 are located in ahousing disposed in a region outside or inside the body.

Two preferred embodiments of the airway implant device are shown inFIGS. 31 and 32. The device in FIG. 31 includes the actuator element 8connected to an anode 10 and cathode 12 and to the induction coil 18.The device also includes a controller 90, such as a microprocessor. Thecircuitry within the controller is not shown. The controller 90 picks upAC signals from the induction coil 18 and converts it to DC current. Thecontroller 90 can also include a time delay circuit and/or a sensor. Thesensor could sense the collapsing and/or narrowing of the airways andcause the device to energize the actuator element 8 and thus completelyor partially open up the airway in which the device is implanted. FIG.32 shows an embodiment with anchors 91 located on the actuator element8. The implant can be anchored in a suitable location with the use ofthese anchors and sutures and/or surgical glue.

FIG. 42 depicts an embodiment of the invention. The airway implantdevice comprises of two units—an implant unit and a retainer unit. Theimplant unit is implanted in a patient and includes an IPMC actuator anda coil. The retainer unit is typically not implanted in the patient andcan be worn by the patient prior to going to bed. This unit includes acoil, a battery, and a microcontroller.

FIG. 43 depicts yet another embodiment of the invention. FIG. 43A is theimplant unit, preferably for implantation proximal to or in an airwaywall. The implant unit includes an actuator element 8, an inductor 18 inthe form of a coil, a controller 90, and connecting elements 6. FIG. 43Bdepicts the removable retainer with an inductor 16 and a retainer 66.

FIGS. 44A, 44B, and 44C illustrate terms used in describing the anatomyof a patient 88 and orientation attributes of the invention. Anterior100 refers to a part of the body or invention toward the front of thebody or invention, or in front of another part of the body or invention.Posterior 102 refers to a part of the invention or body toward the backof the invention or body, or behind another part of the invention orbody. Lateral 104 refers to a part of the invention or body to the sideof the invention or body, or away from the middle of the invention orbody or the middle of the invention or body. Superior 106 refers to apart of the invention or body toward the top of the invention or body.Inferior 108 refers to a part of the invention or body toward the bottomof the invention or body. FIG. 44B illustrates the left 226 and theright 228 sides of a patient anatomy. Various planes of view areillustrated in FIG. 44C, including a coronal plane 230, a transverseplane 232, and a sagittal plane 230.

A preferred embodiment of the device of the present invention comprisesan implanted portion 20 comprising an implantable actuator element 8, ahousing 112, a first inductor 18, and connecting elements 14 connectingthe actuator element 8 to the first inductor 18 within the housing 112;and a non-implanted portion 22 comprising a power source 4 and a secondinductor 16 capable of transferring energy to the first inductor 18,wherein the energy of the first inductor 18 energizes the actuatorelement 8 wherein the actuator element 8 comprises an electroactivepolymer element. In a preferred embodiment, the actuator element 8 ofthe device is implanted in the soft palate 84. The housing 112 of thepreferred embodiment is implanted inferior to the hard palate 74. In apreferred embodiment of the device, the housing 112 comprises at leastone of acrylic, polytetrafluoroethylene (PTFE), polymethylmethacrylate(PMMA), Acrylonitrile Butadiene Styrene (ABS), polyurethane,polycarbonate, cellulose acetate, nylon, and a thermoplastic orthermosetting material.

In a preferred embodiment, the non-implanted portion 22 is in the formof a mouth guard or dental retainer 66. In a preferred embodiment, thenon-implanted portion comprises a non-implantable wearable element. Insome embodiments, the superior side of the housing 112 comports to theshape of a hard palate 74. In some embodiments, the housing 112 is castfrom an impression of a hard palate 74. In still other embodiments, thehousing 112 is concave on its superior side. In some embodiments, thehousing 112 is convex on its superior side. In some embodiments, thehousing 112 comprises bumps 114 on its superior side lateral to acentral axis extending from the housing's 112 anterior to its posteriorend. In some embodiments, the housing 112 configuration has asubstantially smooth rounded superior side. Other configurations for thehousing 112 may be contemplated by one having skill in the art withoutdeparting from the invention.

In some embodiments, the actuator element 8 is at least partially withinthe housing 112. In other embodiments, the actuator element 8 is outsidethe housing 112. The housing 112 is capable of housing and protectingthe first inductor 18 and connecting elements 14 between the firstinductor 18 and the actuator element 8. In some embodiments, the housing112 has a roughened surface to increase friction on the housing 112. Insome embodiments, the roughened surface is created during casting of thehousing 112. In some embodiments, the roughened surface inducesfibrosis.

FIG. 45A illustrates one embodiment of the airway implant devicecomprising a actuator element 8, a first inductor 18, and a housing 112made from an acrylic and cast with substantially smooth rounded superiorand anterior sides. In this embodiment, the actuator element 8 anteriorend terminates at about the posterior end of the acrylic housing 112.FIG. 45B illustrates the implant device of FIG. 45A viewed from theanterior side of the implant device, looking toward the posterior end,wherein the implant device is implanted in the palate 116. In theembodiment shown in FIG. 45B, the implant device is implanted such thatthe housing 112 is in the periosteum 118 inferior to the ridge of thehard palate 74, and the actuator element 8 extends into the soft palate84.

FIG. 46A illustrates an embodiment of the airway implant device that hasa actuator element 8, a first inductor 18, and a housing 112 with asmooth rounded inferior side, and at least two bumps 114 on its superiorside which, when implanted, comport with the lateral sides of the ridgeof the hard palate 74, as shown in FIG. 46B. This configuration reducesrocking of the implant device on the ridge of the hard palate 74 whenimplanted. In this embodiment, the actuator element 8 anterior endterminates at about the posterior end of the acrylic housing 112. FIG.46B illustrates the airway implant device of FIG. 46A, viewed from theanterior side of the implant, looking toward the posterior end, whereinthe implant device is implanted in the palate 116. In the embodimentshown in FIG. 46B, the implant device is implanted such that the housing112 is in the periosteum 118 inferior to the ridge of the hard palate74, and the actuator element 8 extends into the soft palate 84.

FIG. 47A illustrates an embodiment of the airway implant device havingan attachment element 120 at the anterior end of the implant. In thisembodiment, the attachment element 120 is T-shaped, however, otherconfigurations and geometries of the attachment element 120 arecontemplated in other embodiments, including triangular, circular,L-shaped, Z-shaped, and any geometry within the contemplation of oneskilled in the art that would allow attachment of the attachment elementto tissue at the anterior end of the implant to fix the position of theimplant within the implant cavity.

In some embodiments of the airway implant device having attachmentelements 120, the attachment element 120 is a bioabsorbable material.Examples of bioabsorbable materials include, but are not limited to,polylactic acid, polyglycolic acid, poly(dioxanone),Poly(lactide-co-glycolide), polyhydroxybutyrate, polyester, poly(aminoacid), poly(trimethylene carbonate) copolymer, poly (ε-caprolactone)homopolymer, poly (ε-caprolactone) copolymer, polyanhydride,polyorthoester, polyphosphazene, and any bioabsorbable polymer.

In another embodiment, the airway implant device comprises an attachmentelement 120, as shown in FIG. 47B wherein the perforated attachmentelement 120 comprises at least one hole 122. The hole provides a meansfor a suture or other attaching device to affix the device to tissue andsecure the implant device position. In the case where a suture 132 isused, the suture may or may not be the same suture used by apractitioner to close the original incision made to create a cavity forthe implant. The attaching device comprises at least one of a suture,clip, staple, tack, and adhesive.

In some embodiments, the implant may be secured in place, with orwithout use of an attachment element 120, using an adhesive suitable fortissue, such as cyanoacrylates, and including, but not limited to,2-octylcyanoacrylate, and N-butyl-2-cyanoacrylate.

FIG. 48 illustrates an embodiment of the airway implant device whereinthe housing 112 has at least one anchor 124. In FIG. 48, the device hasfour saw-blade like directional anchors 124. The anchors 124 may or maynot be made of made of the same materials as the housing 112. Suchmaterials include at least one of acrylic, polytetrafluoroethylene(PTFE), polymethylmethacrylate (PMMA), Acrylonitrile Butadiene Styrene(ABS), polyurethane, polycarbonate, cellulose acetate, nylon, and athermoplastic material. In some embodiments, the device has at least oneanchor 124. In some embodiments, the anchor 124 is configured to allowdelivery and removal of the implant device with minimal tissue damage.In some embodiments, the anchor 124 is curved. In some embodiments thesuperior side(s) of the anchor(s) 124 comport with the hard palate 74surface. In other embodiments, the superior side(s) of the anchor(s) 124conform to the configuration of the housing 112, options for which areas described elsewhere in this disclosure.

FIG. 49 illustrates a preferred embodiment of the airway implant devicewherein the implanted portion 20 comprises power connecting elements 14comprising a first contact 26 and a second contact 28. In thisembodiment, the first contact 26 and second contact 28 have opposingelectrical charges, and the housing 112 encases the contacts. In theembodiment shown, the first contact 26 faces in the inferior direction,while the second contact 28 faces in the superior direction. In otherembodiments, the first contact 26 faces in the superior direction whilethe second contact 28 faces in the inferior direction. In someembodiments, the connecting element 14 comprises a non-corrosiveconductive material. In some embodiments, the connecting element 14comprises platinum, gold, silver, stainless steel, or conductive carbon.In some embodiments, the connecting element 14 comprises stainless steelor copper plated with gold, platinum, or silver. In some embodiments,the actuator element 8 stiffens in one direction when a charge isapplied to the connecting element 14. In some embodiments, the actuatorelement 8 deflects when a charge is applied to the connecting element14.

FIG. 50 illustrates an embodiment of the airway implant system whereinthe device comprises a non-implanted portion 22 in the form of, and madefrom similar material as a dental retainer 66. The retainer 66 depictedin FIG. 50 has teeth impressions 126 corresponding to a patient'sapproximate or exact dentition. Example dental retainer materialsinclude acrylate, polymethylmethacrylate (PMMA), polycarbonate, andnylon. In the embodiment shown in FIG. 50, the non-implanted portioncomprises a power source 4 that is rechargeable, a second inductor 16connected to the power source 4, and ball clamps 128 having two exposedportions 130, said ball clamps 128 connected to the rechargeable powersource 4, whereby the exposed portions 130 can recharge the power source4. The exposed portions 130 are at least partially not covered byretainer material, and are thereby exposed. In the embodiment shown inFIG. 50, the non-implanted portion second inductor 16 transfers energyit receives from the power source 4 to the first inductor 18 of theimplanted portion 20, wherein the first inductor 18 energizes theactuator element 8.

In some embodiments, the non-implanted portion 22 does not include ballclamps 128 for recharging the power source 4. In some embodiments, thepower source 4 is a rechargeable battery. In some embodiments, the powersource 4 is one of a lithium-ion battery, lithium-ion polymer battery, asilver-iodide battery, lead acid battery, a high energy density, or acombination thereof. In some embodiments, the power source 4 isremovable from the non-implanted portion 22. In some embodiments, thepower source 4 is replaceable. In some embodiments, the power source isdesigned to be replaced or recharged per a specified time interval. Insome embodiments, replacing or recharging the power source 4 isnecessary no more frequently than once per year. In other embodiments,replacing or recharging the power source 4 is necessary no morefrequently than once every six months. In yet other embodiments,replacing or recharging the power source 4 is necessary no morefrequently than once or every three months. In yet another embodiment,daily replacing or recharging of the power source is required.

In some embodiments, the power source 4 and second inductor 16 aresealed within the non-implanted portion and the sealing is liquid proof.

FIGS. 51A, and 51B illustrate different views of an embodiment of theairway implant device non-implanted portion 22 in the form of a retainer66. In the embodiment depicted, the non-implanted portion 22 comprises asecond inductor 16, a power source 4, and at least one balldclamp 128for recharging the power source 4.

FIG. 52 illustrates an embodiment of the airway implant device implantedin the palate 116. In this embodiment, the housing 112 is implantedinferior to the hard palate 74, whereas the actuator element 8 extendsposterior to the housing 112 into the soft palate 84. The non-implantedportion 22 in this embodiment comprises a retainer 66, a power source 4,a second inductor 16, and ball clamps 128 for recharging the powersource 4. Other embodiments may comprise none, or some, or all of theseelements (the retainer 66, power source 4, second inductor 16, and ballclamps 128), and instead open the airway by means described elsewhere inthis specification. In the embodiment depicted in FIG. 52, when theimplanted portion 20 of the airway implant device is implanted such thatthe housing 112 is inferior to the hard palate 74, and when a patientplaces the retainer 66 in his mouth 82, the retainer 66 having achargeable second inductor 16 that is positioned within the retainer 66to align inferior to the implanted first inductor 18, the secondinductor 16 transfers energy to the first inductor 18 and the firstinductor 18 energizes the actuator element 8. In this embodiment, theactuator element 8 comprises an electroactive polymer (EAP) element,which, when energized by the first inductor 18, opens the airway inwhich the device is implanted.

The implants described herein are preferably implanted with a deploymenttool. Typically, the implantation involves an incision, surgicalcavitation, and/or affixing the implant.

Sensing and Actuation of Airway Implants

One embodiment of the invention is an airway implant device with asensor for monitoring a condition prior to and/or during the occurrenceof an apneic event. Preferably, the sensor monitors for blockage of anairway. The sensor senses the possible occurrence of an apneic event.This sensing of a possible apneic event is typically by sensing adecrease in the airway gap, a change in air pressure in the airway, or achange in air flow in the airway. A progressive decrease in the airwaygap triggers the occurrence of an apneic event. Most preferably thesensor senses one or more events prior to the occurrence an apneic eventand activates the airway implant to prevent the apneic event. In someembodiments, the airway implant device and the sensor are in the sameunit. In other embodiments, the actuator element of the airway implantdevice is the sensor. In these embodiments, the actuator element acts asboth a sensor and actuator. In yet other embodiments, the airway implantdevice and the sensor are in two or more separate units.

FIG. 37 depicts the occurrence of an apneic event due to the blockage ofairway 3701 caused by the movement of the soft palate 84. FIG. 37A showsthe soft palate 84 position during normal breathing cycle. An airway gap3803 is maintained between the soft palate 84 and the laryngeal wall3804 to maintain airflow 3805. FIG. 37B shows the position of the softpalate 84 just prior to the airway 3701 blockage. It can be seen thatthe gap 3803′ in this case is smaller than the gap 3803 in FIG. 37A.FIG. 37C shows the soft palate 84 blocking the airway 3701′, leading tothe occurrence of an apneic event. In one aspect of the invention, theevent shown in FIG. 37C is prevented by taking preemptive action duringoccurrence of event depicted in FIG. 37B.

One aspect of the invention is an airway implant device with a sensorfor sensing the occurrence of apneic events and actuating the device.The invention also includes methods of use of such device.

One embodiment of an airway implant device with sensor is depicted inFIG. 38. Non-contact distance sensors 3801 and 3802 are mounted on thelaryngeal wall 3804 and also on the soft palate 84 to sense the airwaygap between the soft palate 84 and the laryngeal wall 3804. One or moregap values are calibrated into a microcontroller controlling the airwayimplant device. The functioning of the airway implant device with asensor is depicted in FIG. 39. During the occurrence of the apneic eventthe gap between the soft palate 84 and the laryngeal wall 3804decreases. This gap information is continuously monitored by the airwayimplant device microcontroller. When the gap becomes smaller than apreset threshold value, the airway implant microcontroller actuates theairway implant, which stiffens the soft palate 84 and the gap betweenthe soft palate 84 and the laryngeal walls 3804 increases. When this gapcrosses an upper threshold, the microcontroller powers off the airwayimplant actuator.

In one embodiment, the operation of the device is as follows:

-   -   a) A threshold gap is calibrated into the microcontroller which        is present in the removable retainer of the device. This        threshold gap corresponds to the gap 3803′ formed by the        position of the soft palate with respect to the laryngeal wall        as depicted in the FIG. 37B, i.e., a distance at which an apneic        event could be triggered or an apneic event occurs. This        calibration can take place in real time or when the device is        being installed.    -   b) The non-contact sensor constantly monitors the gap and the        information is constantly analyzed by a program present in the        microcontroller.    -   c) The airway implant actuator is in the off state (not powered        state) as long as the threshold gap is not reached.    -   d) When the gap is equal to the threshold gap, the micro        controller, powers on the airway implant actuator (on state).        This leads to the stiffening of the airway implant actuator,        which in-turn stiffens the soft palate.    -   e) This stiffening of the soft palate prevents the obstruction        of the airway and modulates the occurrence of an apneic event.    -   f) When the gap becomes more than the threshold gap, the        micro-controller turns off the airway implant actuator (off        state).

Typically, an algorithm in the micro-controller controls the actuationof the actuator. An example of the algorithm is—

-   -   if (gap<threshold gap); {Voltage applied to airway implant        actuator=high (on state)} or else {Voltage applied to the airway        implant actuator=low (off state)}

Complex algorithms, such as adaptive algorithms, can also be used. Theobjective of the adaptive algorithm can be to selectively control thestiffness of the soft palate by varying the power applied to the airwayimplant actuator.

Another example of an algorithm to selectively control the stiffness ofthe soft palate is:

-   -   If (gap<or=g)    -   {Apply full power to the airway implant actuator}    -   Else    -   If (gap=g1)    -   {Voltage applied to airway implant actuator=v1}    -   Else if (gap=g2)    -   {Voltage applied to airway implant actuator=v2}    -   Else if (gap=g3)    -   {Voltage applied to airway implant actuator=v3}    -   Note (g1, g2, g3>g)

An example of a controller to maintain a predetermined reference gap isshown is FIG. 41. The objective of this algorithm is to maintain anactual airway gap g_(act) as close to the reference airway gap g_(ref)as possible by controlling the airway implant device actuator. Theactual airway gap between the soft palate and the laryngeal wall g_(act)is measured and this information is the output of the position sensor.This airway gap information is feedback to the microcontroller which hasa controller algorithm embedded in it. In the microcontroller theg_(act) is compared to a g_(ref) and based on the difference betweenboth, the Proportional Integral Derivative (PID) controller generates acontrolling voltage which is supplied to the airway implant device. ThePID controller can have fixed gains or can have the gains adaptivelytuned based on system information.

In alternative embodiments, the sensor can be a wall tension sensor, anair pressure sensor, or an air flow monitoring sensor. In anotherembodiment, instead of fully turning the airway implant actuator on oroff, the actual value of the airway gap can be used to selectively applyvarying voltage to the airway implant actuator, hence selectivelyvarying the stiffness of the soft palate. In yet another embodiment, ifthe airway implant actuator exhibits a lack of force retention over anextended period of time under DC voltage, a feedback control algorithmmay be implemented in the microcontroller, which uses the sensoryinformation provided by the sensors to control the stiffness of the softpalate by maintaining the force developed by the airway implantactuator.

Another embodiment of the invention is depicted in FIG. 40. In thisembodiment, the wall tension sensed by the wall tension sensor 4001implanted into the laryngeal wall 3804 is used as a threshold criterionfor activating the airway implant actuator. A wall tension sensor canalso be placed in a pharyngeal wall or other suitable airway wall. Thesensors of this invention can be placed in an airway wall or proximal toan airway wall.

Some of the advantages of the use of an airway sensor with an airwayimplant device include: optimization of the power consumed by the airwayimplant device and hence extension of the life of the device; assistancein predicting the occurrence of apneic event, and hence selectiveactivation of the device in order to minimize any patient discomfort;flexibility to use a feedback control system if required to compensatefor any actuator irregularities; and possible configuration of thesystem to interact with an online data management system which willstore different parameters related to apneic events for a patient. Thissystem can be accessed by the doctor, other health care providers, andthe insurance agency which will help them provide better diagnosis andunderstanding of the patient's condition.

In preferred embodiments, the airway gap is individually calculated andcalibrated for each patient. This information can be stored in themicrocontroller. The sensors are described herein mainly in the contextof airway implant devices comprising of electroactive polymer actuators.The sensors can also be used with airway implant devices comprisingother active actuators, i.e., actuators that can be turned on, off, orotherwise be controlled, such as magnets. The sensors can be used toactivate, in-activate, and/or modulate magnets used in airway implantdevices. Preferably, the sensors are in the form of a strip, but can beany other suitable shape for implantation. They are typically deployedwith a needle with the help of a syringe. The sensor can be made withany suitable material. In preferred embodiments, the sensor is a smartmaterial, such as an IPMC. The sensor is typically in connection with amicrocontroller, which is preferably located in the retainer. Thisconnection can be either physical or wireless.

Suitable sensors include, but are not limited to, an electroactivepolymer like ionic polymer metal composite (IPMC). Suitable materialsfor IPMC include perfluorinated polymer such as polytetrafluoroethylene,polyfluorosulfonic acid, perfluorosulfonate, and polyvinylidenefluoride. Other suitable polymers include polyethylene, polypropylene,polystyrene, polyaniline, polyacrylonitrile, cellophane, cellulose,regenerated cellulose, cellulose acetate, polysulfone, polyurethane,polyvinyl acetate. Typically, the electroactive polymer element includesa biocompatible conductive material such as platinum, gold, silver,palladium, copper, and/or carbon. Commercially available materialssuitable for use as a sensor include Nafion® (made by DuPont), Flemion®(made by Asahi Glass), Neosepta® (made by Astom Corporation), Ionac®(made by Sybron Chemicals Inc), Excellion™ (made by Electropure). Othermaterials suitable for use as a sensor include materials withpiezoelectric properties like piezoceramics, electrostrictive polymers,conducting polymers, materials which change their resistance in responseto applied strain or force (strain gauges) and elastomers.

The airway implant devices of the present invention, with or without thesensor, can be used to treat snoring. For snoring, the sensor can beadapted and configured to monitor air passageways so as to detect thepossible occurrence of snoring or to detect the possible worsening ofongoing snoring. Preferably the sensors are capable of detectingrelaxation of tissues in the throat, which can cause them to vibrate andobstruct the airway. Other tissues that can be monitored by the sensorinclude the mouth, the soft palate, the uvula, tonsils, and the tongue.

Another disease that can be treated with the devices of the presentinvention includes apnea. The sensor preferably monitors the throattissue for sagging and/or relaxation to prevent the occurrence of anapneic event. Other tissues that can be monitored by the sensor includethe mouth, the soft palate, the uvula, tonsils, and the tongue.

Methods of Making Electroactive Polymer Element

In some embodiments, the EAP element is an IPMC strip which is made froma base material of an ionomer sheet, film or membrane. The ionomer sheetis formed using ionomer dispersion.

IPMC is made from the base ionomer of, for example, polyethylene,polystyrene, polytetrafluoroethylene, polyvinylidene fluoride (PVDF)(e.g., KYNAR® and KYNAR Flex®, from ATOFINA, Paris, France, and SOLEF®,from Solvay Solexis S.A., Brussels, Belgium), hydrophilic-PVDF (h-PVDF),polyfluorosulfonic acid based membranes like NAFION® (from E.I. Du Pointde Nemours and Company, Wilmington, Del.), polyaniline,polyacrylonitrile, cellulose, cellulose acetates, regenerated cellulose,polysulfone, polyurethane, and combinations thereof. The conductivematerial that is deposited on the ionomer can be gold, platinum, silver,palladium, copper, graphite, conductive carbon, or combinations thereof.Conductive material is deposited on the ionomer either by electrolysisprocess, vapor deposition, sputtering, electroplating, or combination ofprocesses.

The IPMC is cut into the desired implant shape for the EAP element. Theelectrical contact (e.g., anode and cathode wires for EAP element) isconnected to the IPMC surfaces by, for example, soldering, welding,brazing, potting using conductive adhesives, or combinations thereof.The EAP element is configured, if necessary, into specific curved shapesusing mold and heat setting processes.

In some embodiments, the EAP element is insulated with electricalinsulation coatings. Also, the EAP element can be insulated withcoatings that promote cell growth and minimize fibrosis, stop cellgrowth, or kill nearby cells. The insulation can be a biocompatiblematerial. The EAP element is coated with polymers such as polypropylene,poly-L-lysine, poly-D-lysine, polyethylene glycol, polyvinyl alcohol,polyvinyl acetate, polymethyl methacrylate, or combinations thereof. TheEAP element can also be coated with hyaluronic acid. The coating isapplied to the device by standard coating techniques like spraying,electrostatic spraying, brushing, vapor deposition, dipping, etc.

In one example, a perfluorosulfonate ionomer, PVDF or h-PVDF sheet isprepared for manufacturing the EAP element. In an optional step, thesheet is roughened on both sides using, for example, about 320 grit sandpaper and then about 600 grit sand paper; then rinsed with deionizedwater; then submerged in isopropyl alcohol (IPA); subjected to anultrasonic bath for about 10 minutes; and then the sheet is rinsed withdeionized water. The sheet is boiled for about 30 minutes inhydrochloric acid (HCL). The sheet is rinsed and then boiled indeionized water for about 30 minutes. The sheet is then subject toion-exchange (i.e., absorption). The sheet is submerged into, orotherwise exposed to, a metal salt solution at room temperature for morethan about three hours. Examples of the metal salt solution aretetraammineplatinum chloride solution, silver chloride solution,hydrogen tetrachloroaurate, tetraamminepalladium chloride monohydrate orother platinum, gold, silver, carbon, copper, or palladium salts insolution. The metal salt solution typically has a concentration ofgreater than or equal to about 200 mg/100 ml water. 5% ammoniumhydroxide solution is added at a ratio of 2.5 ml/100 ml to thetetraammineplatinum chloride solution to neutralize the solution. Thesheet is then rinsed with deionized water. Primary plating is thenapplied to the sheet. The sheet is submerged in water at about 40° C. 5%solution by weight of sodium borohydride and deionized water is added tothe water submerging the sheet at 2 ml/180 ml of water. The solution isstirred for 30 minutes at 40° C. The sodium borohydride solution is thenadded to the water at 2 ml/180 ml of water and the solution is stirredfor 30 minutes at 40° C. This sodium borohydride adding and solutionstirring is performed six times total. The water temperature is thengradually raised to 60° C. 20 ml of the sodium borohydride solution isthen added to the water. The solution is stirred for about 90 minutes.The sheet is then rinsed with deionized water, submerged into 0.1N HCIfor an hour, and then rinsed with deionized water.

In some embodiments, the sheet receives second plating. The sheet issubmerged or otherwise exposed to a tetraammineplatinum chloridesolution at a concentration of about 50 mg/100 ml deionized water. 5%ammonium hydroxide solution is added at a rate of 2 ml/100 ml oftetrammineplatinum chloride solution. 5% by volume solution ofhydroxylamine hydrochloride in deionized water is added to thetetraammineplantium chloride solution at a ratio of 0.1 of the volume ofthe tetraammineplatinum chloride solution. 20% by volume solution ofhydrazine monohydrate in deionized water is added to thetetraammineplatinum chloride solution at a ratio of 0.05 of the volumeof the tetraammineplantinum chloride solution. The temperature is thenset to about 40° C. and the solution is stirred.

A 5% solution of hydroxylamine hydrochloride is then added at a ratio of2.5 m/100 ml of tetraammineplatinum chloride solution. A 20% solution ofhydrazine monohydrate solution is then added at a ratio of 10.25 ml/100ml tetraammineplatinum chloride solution. The solution is stirred for 30minutes and the temperature set to 60° C. The above steps in thisparagraph can be repeated three additional times. The sheet is thenrinsed with deionized water, boiled in HCI for 10 minutes, rinsed withdeionized water and dried.

In some embodiments, the polymer base is dissolved in solvents, forexample dimethyl acetamide, acetone, methylethyle ketone, toluene,dimethyl carbonate, diethyl carbonate, and combinations thereof. Thesolvent is then allowed to dry, producing a thin film. While thesolution is wet, a low friction, (e.g., glass, Teflon) plate is dippedinto the solution and removed. The coating on the plate dries, creatinga think film. The plate is repeatedly dipped into the solution toincrease the thickness of the film.

Polyvinyl alcohol, polyvinyl pyrrolidone, polyinyl acetate orcombinations thereof can be added to a PVDF solution before drying, thuscontributing hydrophilic properties to PVDF and can improve ionmigration through the polymer film during manufacture. Dye or othercolor pigments can be added to the polymer solution.

Method of Using

FIG. 25 illustrates an embodiment of a method of the airway implantdevice of the present invention. In this embodiment, the first inductor18 is implanted in the mouth roof 72, for example in or adjacent to thehard palate 74. Wire leads 6 connect the first inductor 18 to theactuator elements 8 a, 8 b, and 8 c. A first actuator element 8 a isimplanted in the base of the tongue at the pharynx wall 76. A secondactuator element 8 b is integral with the first actuator element 8 a(e.g., as two sections of a hollow cylindrical actuator element 8, suchas shown in FIG. 17). The first and second actuator elements 8 a and 8 bcan be separate and unattached elements. The third actuator element 8 cis implanted in the uvula and/or soft palate 84. The actuator elements 8can also be implanted in the wall of the nasal passages 78, higher orlower in the pharynx 79, such as in the nasal pharynx, in the wall ofthe trachea 80, in the larynx (not shown), in any other airway, orcombinations thereof. The second inductor 16 is worn by the patient inthe mouth 82. The second inductor 16 is connected to an integral ornon-integral power source. The second inductor 16 comprises one ormultiple induction coils. The second inductor 16 inductively transmitsRF energy to the first inductor 18. The first inductor 18 changes the RFenergy into electricity. The first inductor 18 sends a charge or currentalong the wire leads 6 to the actuator elements 8 a, 8 b, and 8 c. Theactuator elements 8 a, 8 b, and 8 c are energized by the charge orcurrent. The energized actuator elements 8 a, 8 b, and 8 c increase thestiffness and/or alter the shape of the airways. The energized actuatorelements 8 a, 8 b, and 8 c modulate the opening of the airways aroundwhich the actuator elements 8 a, 8 b, and 8 c are implanted. Thenon-energized actuator elements 8 a, 8 b, and 8 c are configured toconform to the airway around which the actuator elements 8 a, 8 b, and 8c are implanted. The non-energized actuator elements 8 a, 8 b, and 8 care flexible and soft.

FIG. 26 illustrates another embodiment of the invention. In thisembodiment, the first inductor 18 is implanted in the mouth roof 72 andattached to a actuator element 8 via the wire lead 6. The actuatorelement 8 is preferably in the soft palate 84. In another embodiment,FIG. 27 illustrates that the first inductor 18 is implanted in the mouthroof 72 and attached to two actuator elements 8 via two wire leads 6.The actuator elements 8 are implanted in side walls 86 of the mouth 82.In yet another embodiment, as illustrated in FIG. 28, the first inductor18 is implanted in the mouth roof 72 and attached to three actuatorelements 8 via three wire leads 6. The actuator elements 8 are implantedin the soft palate 84 and the side walls 86 of the mouth 82. FIG. 29illustrates an embodiment in which the first conductors (not shown,e.g., the tooth sockets), are attached to, and in conductive electricalcommunication with, the second conductors. The retainer 66, such asshown in FIG. 23, can be worn by the patient to energize the actuatorelement 8. The tooth sockets are removably attached to the firstconductors 34. The first conductors 34 are dental fillings, conductiveposts adjacent to and/or through the teeth 64.

FIG. 33 illustrates an embodiment in which a patient 88 has the firsttransducer (not shown) implanted in the patient's cheek and wears thenon-implanted portion 22, such as shown in FIG. 24, on the outside ofthe patient's cheek. The non-implanted portion 22 energizes theimplanted portion (not shown).

FIGS. 34-36 depict some of the ways in which the implant devicesfunction to open the airways. FIGS. 34A and 34B depict a side view of apatient with a soft palate implant 8 c and a non-implanted portion ofthe device, with a second inductor 16, which in this case is a wearablemouth piece. The wearable mouth piece includes a transmitter coil, apower source, and other electronics, which are not depicted. Also, shownis a first inductor 18. The implant device has the ability to sense anddeflect the tongue so as to open the airway. FIG. 34A depicts the tongue92 in its normal state. During sleep, when the tongue collapses 92′, asshown in FIG. 34B, the actuator element 8 c′ senses the collapsed tongueand is energized via the mouthpiece and first inductor and it stiffensto push away the tongue from the airway and keeps the airway open. Thisopening of the airway can be partial or complete. In some embodiments,particularly the embodiments without the sensor, the implant is poweredwhen the patient is asleep such that the actuator element 8 is energizedand keeps the collapsed tongue away from the airway.

FIGS. 35 and 36 depict an embodiment of keeping the airways open withlateral wall implants. FIG. 35A shows a side view of a patient's facewith a actuator element 8 located in the lateral wall of the airway.FIG. 35A depicts the tongue 92 in its normal state. FIG. 35B depicts thetongue 92′ in a collapsed state. When the tongue is in this state orbefore it goes into the collapsed state the actuator element 8 isenergized so as to stretch the lateral walls and open the airway, asshown in FIG. 36B. FIGS. 36A and 36B are a view of the airway as seenthrough the mouth of patient. FIG. 36 A depicts the actuator elements 8in a non-energized state and the tongue in a non-collapsed state. Whenthe tongue collapses or it has a tendency to collapse, such as duringsleep, the actuator element 8 is energized and airway walls are pushedaway from the tongue and creates an open air passageway 93. Thisembodiment is particularly useful in obese patients.

Airway Diseases

During sleep, the muscles in the roof of the mouth (soft palate), tongueand throat relax. If the tissues in the throat relax enough, theyvibrate and may partially obstruct the airway. The more narrowed theairway, the more forceful the airflow becomes. Tissue vibrationincreases, and snoring grows louder. Having a low, thick soft palate orenlarged tonsils or tissues in the back of the throat (adenoids) cannarrow the airway. Likewise, if the triangular piece of tissue hangingfrom the soft palate (uvula) is elongated, airflow can be obstructed andvibration increased. Being overweight contributes to narrowing of throattissues. Chronic nasal congestion or a crooked partition between thenostrils (deviated nasal septum) may be to blame.

Snoring may also be associated with sleep apnea. In this seriouscondition, excessive sagging of throat tissues causes your airway tocollapse, preventing breathing. Sleep apnea generally breaks up loudsnoring with 10 seconds or more of silence. Eventually, the lack ofoxygen and an increase in carbon dioxide signal causes the person towake up, forcing the airway open with a loud snort.

Obstructive sleep apnea occurs when the muscles in the back of thethroat relax. These muscles support the soft palate, uvula, tonsils andtongue. When the muscles relax, the airway is narrowed or closed duringbreathing in, and breathing is momentarily cut off. This lowers thelevel of oxygen in the blood. The brain senses this decrease and brieflyrouses the person from sleep so that the airway can be reopened.Typically, this awakening is so brief that it cannot be remembered.Central sleep apnea, which is far less common, occurs when the brainfails to transmit signals to the breathing muscles.

Thus, it can be seen that airway disorders, such as sleep apnea andsnoring, are caused by improper opening of the airway passageways. Thedevices and methods described herein are suitable for the treatment ofdisorders caused by the improper opening of the air passageways. Thedevices can be implanted in any suitable location such as to open up theairways. The opening of the passageways need not be a complete openingand in some conditions a partial opening is sufficient to treat thedisorder.

In addition to air passageway disorders, the implants disclosed hereinare suitable for use in other disorders. The disorders treated with thedevices include those that are caused by improper opening and/or closingof passageways in the body, such as various locations of thegastro-intestinal tract or blood vessels. The implantation of thedevices are suitable for supporting walls of passageways The devices canbe implanted in the walls of the gastro-intestinal tract, such as theesophagus to treat acid reflux. The gastro-intestinal tract or bloodvessel devices can be used in combination with the sensors describedabove. Also, the implants and/or sphincters can be used for disorders offecal and urinary sphincters. Further, the implants of said inventioncan be tailored for specific patient needs.

IPMC Based Implantable OSA Sensor

FIG. 53A shows an implantable OSA sensor 200, according to oneembodiment of the invention. It should be understood that the term“implantable” does not limit the use of the implantable OSA sensor 200,or any other sensor described herein. Thus, the implantable OSA sensor200, or any other sensor described herein, may be permanently ortemporarily coupled to a patient, for example for several minutes,hours, weeks, or years. The implantable OSA sensor 200, or any othersensor described herein, may also be reused and coupled to a patientintermittently, for example during sleep periods. The implantable OSAsensor 200 includes an ionic polymer metal composite (IPMC) sensor 202coupled to a transmitter device 204. The IPMC sensor 202 may beconfigured as an elongated strip. In one embodiment the sensor 202includes a length of 80 mm and a width of 40 mm, and thickness of0.2-0.4 mm. The IPMC sensor 202 includes a ionic polymer layer withmetal coated on both sides. The metal coating functions as an electrodeand may be for example platinum. The IPMC sensor 202 functions on theprincipal that when hydrated, for example with saliva, movement ormechanical bending of the IPMC sensor 202 causes cations (positivelycharged ions) to move from a high density region (e.g. an interiorradius region of a bend) to a low density region (e.g. an outer radiusregion of a bend). Accordingly, during bending, cations will accumulatein the electrodes to create a detectable electrical output, which may bea charge or voltage. The IPMC sensor 202 is very advantageous becausethe it does not require a power source to generate an electrical output.The transmitter device 204 is electrically and mechanically coupled tothe IPMC sensor 202 to receive generated electrical output. Thetransmitter device 204 generally includes a housing for supportingelectronic circuitry. The transmitter device 204 and the IPMC sensor 202may be integrally constructed, as shown. The IPMC sensor 202 may beconstructed similarly to the IPMC actuators disclosed herein.

FIG. 53B shows a schematic diagram of the implantable OSA sensor 200,according to one embodiment of the invention. The IPMC sensor 202 iselectrically coupled to translation circuitry 206. The translationcircuitry 206 may translate an incoming electrical output from the IPMCsensor 202 into a wirelessly propagated signal. For example thetranslation circuitry 206 may include amplification or conversioncircuitry. The translation circuitry 206 may convert the incomingelectrical output into an analog or a digital signal. The translationcircuitry 206 will also include transmission circuitry for wirelesstransmission of a signal according to a transmission standard, forexample WiFi, Bluetooth 1.1 and greater, or IEEE802.11. A wirelesstransmitter 208 is electrically coupled to the translation circuitry206, for transmission of a signal. The translation circuitry 206 mayalso be controlled from an outside source through the wirelesstransmitter 208. A battery 210 provides power to the translationcircuitry 206 and wireless transmitter 208. The battery 210 may berechargeable or replaceable.

FIG. 53C shows an implantable OSA sensor 212, according to oneembodiment of the invention. The implantable OSA sensor 212 isconstructed similarly to the implantable OSA sensor 200 shown in FIGS.53A and 53B. However the IPMC sensor 214 includes a tapered shape whichis longer and profiled to follow the shape of the soft palate. The IPMCsensor 214 may also be custom shaped to match a individual patient'ssoft palate. The IPMC sensor 214 may also be pre-contoured to match thecurve of a patient's soft palate.

FIG. 53D shows an implantable OSA sensor 216, according to oneembodiment of the invention. The implantable OSA sensor 216 isconstructed similarly to the implantable OSA sensor 200 shown in FIGS.53A and 53B. However, the IPMC sensor 218 includes a smaller width andlength which may thus fit inside smaller mouths.

FIG. 53E shows an implantable OSA sensor 220, according to oneembodiment of the invention. The implantable OSA sensor 220 isconstructed similarly to the implantable OSA sensor 200 shown in FIGS.53A and 53B. However, the IPMC sensor 222 includes a smaller width andlonger length shape which thus may be positioned on lateral walls of thesoft palate.

FIG. 53F shows an implantable OSA sensor 224, according to oneembodiment of the invention. The implantable OSA sensor 224 isconstructed similarly to the implantable OSA sensor 200 shown in FIGS.53A and 53B. However, the IPMC sensor 226 includes a smaller width andlength which may fit inside smaller mouths. At least one more IPMCsensor 228 is also shown. The IPMC sensor 228 extends at an angle awayfrom the IPMC sensor 226. The IPMC sensor 228 is shown to be shorter andnarrower than the IPMC sensor 226 and thus may be placed about thepaltoglossal arch.

FIG. 53G shows an implantable OSA sensor 230, according to oneembodiment of the invention. The implantable OSA sensor 230 isconstructed similarly to the implantable OSA sensor 200 shown in FIGS.53A and 53B. However, the IPMC sensor 232 is not integral with thetransmitter device 204. The IPMC sensor 232 is remotely attached to thetransmitter device 204 by cable 234. This configuration is advantageousbecause the transmitter device 204 may be placed in a location away fromthe soft or hard palate, for example outside the mouth. The cable 234may also be detachable from the transmitter device 204, through the useof a reusable connector. The cable 234 may also be detachable from theIPMC sensor 232, through the use of a reusable connector. Thus thepatient may only need to wear or connect the transmitter device 204 whensleeping. The IPMC sensor 232 may involve a rectangular shape as shown,but is not limited to such and may for example take any of the shapesdisclosed herein.

FIG. 53H shows an implantable OSA sensor 236, according to oneembodiment of the invention. The implantable OSA sensor 236 isconstructed similarly to the implantable OSA sensor 230 shown in FIG.53G. However, the implantable OSA sensor 236 includes at least one moreIPMC sensor 238. Two additional IPMC sensors 238 are shown, but more orless may be used. This configuration is advantageous because it allowsfor additional measurements in disparate sections in an airway passageof an oral cavity, for example about the pharyngeal walls, paltoglossalarch, or base of the tongue.

FIG. 54A shows an implantable OSA sensor 300 in use in an airway passageof an oral cavity, according to one embodiment of the invention. Theimplantable OSA sensor 300 is shown extending from the hard palate H tothe soft palate S. The implantable OSA sensor 300 is shown in aconfiguration similar to what is shown in FIG. 53G, but may take theconfiguration of any of the implantable OSA sensors disclosed herein.The transmitter device 302 is shown attached to the hard palate H and anIPMC sensor 304 attached to the soft palate S. The implantable OSAsensor 300 may be attached to the airway passage of an oral cavity byseveral methods. The implantable OSA sensor 300 may be attached by abiocompatible bonding agent or tape. The biocompatible bonding agentalso may be biodegradable, for example over a short period of time, e.g.hours, in order to be easily removed after a period of rest. Theimplantable OSA sensor 300 may also be attached by permanent orbiodegradable sutures. An incision also may be made into the airwaypassage of an oral cavity which the implantable OSA sensor 300 may becompletely or at least partially deposited into and attached by themethods disclosed herein. The IPMC sensor also may be permanentlyattached in an airway passage of an oral cavity, while at least aportion of the transmitter device is detachable and removable forrecharging or servicing.

When a patient experiences an OSA or snoring event the soft palatevibrates at a certain frequency and amplitude. The implantable OSAsensor 300 is vibrated or bent with the soft palate to create anelectrical signal. Accordingly, the electrical signal may indicate anOSA or snoring event. The electrical signal may be transformed orreconfigured by the implantable OSA sensor, and wirelessly transmittedto a secondary device. The position of the OSA sensor 300 is not limitedto the soft palate and may be placed in different positions in theairway passage of an oral cavity.

FIG. 54B shows an implantable OSA sensor 306 in use in an airway passageof an oral cavity, according to one embodiment of the invention. Theimplantable OSA sensor 306 is similar to what is shown in FIG. 53H, butmay take the configuration of any of the implantable OSA sensorsdisclosed herein, for example the implantable OSA sensor in FIG. 53F.The implantable OSA sensor 306 has at least one additional IPMC sensor308. The additional IPMC sensor 308 is placed on a pharyngeal wall P asshown. Thus the additional IPMC sensor 308 may be used to detect an OSAor snoring event according to vibrations or deflections on thepharyngeal wall P.

FIG. 55A shows a flow diagram of a system for detecting an OSA event,according to one embodiment of the invention. At operation 310 a patientexperiences an OSA event or snoring event in an airway passage of anoral cavity. At operation 312 an implantable OSA sensor, previouslycoupled to the patient, detects the OSA event or snoring event, andaccordingly generates an electronic signal. The implantable OSA sensormay also continuously broadcast a signal regardless of whether a snoringor an OSA event occurs, because normal breathing may generally vibratethe implantable OSA sensor enough to constantly generate an electronicsignal. The electrical signal may also be transformed or reconfigured bythe implantable OSA sensor. The implantable OSA sensor then wirelesslytransmits the electronic signal to a remotely located wireless receiverwhich receives the electronic signal in operation 314. The wirelessreceiver may be within short range location (e.g. less than 10 meters)or long range location. For example the wireless receiver may besituated hundreds of miles away from the patient, for example thewireless receiver may be communicated to over air carrier waves, adirect phone line connection, or through a private or publicpacket-based network, such as the internet. The wireless receiver may bein continuous wireless contact with the implantable OSA sensor, or inintermittent contact. For example the implantable OSA sensor maycontinuously broadcast, while the wireless receiver samples thebroadcast at preset intervals. The implantable OSA sensor may alsobroadcast at preset intervals while the wireless receiver is set tocontinuously receive. The implantable OSA sensor may also broadcast atpreset intervals, while simultaneously the wireless receiver issynchronized to receive at the same preset intervals. The wirelessreceiver may also receive signals from other implantable OSA sensors,which may be in the same or a different patient.

At operation 316 a control device receives the electronic signal fromthe wireless receiver. The wireless receiver may be integrated with thecontrol device, or configured as a stand-alone electronic device. Thecontrol device may store the electronic signal for later analysis. Thecontrol device may also provide an analysis of the electronic signal,e.g. interpreting whether the electronic signal represents an OSA event.The analysis may be developed into a predictive algorithm which canpredict OSA events for a specific patient. The controller may optionallyinteract with an OSA therapy device by creating a control algorithm. TheOSA therapy device receives a control signal to indicate that a therapyneeds to be applied to the patient in order to alleviate the OSA event.For example the OSA therapy device may be an IPMC therapy device whichforcibly moves a portion of airway passage of an oral cavity toalleviate the OSA event. In some embodiments the IPMC sensor may beconfigured as an IPMC actuation device as well. Other device may includeelectronically actuated and controlled mandibular repositioning devices,and continuous/bi-level positive airway pressure devices. The wirelessreceiver, control device, and OSA therapy device may also be integrallyhoused into one common electronic device.

FIG. 55B shows a graphed output of an implantable OSA sensor in use inan airway passage of an oral cavity, according to one embodiment of theinvention. The graphed output corresponds to the signal produced by anIPMC sensor, which may be further modified by a transmitter device. Thegraphed output shows a Fluttering signal which may indicate snoring orthe beginning of an OSA event. The Fluttering signal leads to aincreased Partial Obstruction signal. The graph further shows a secondFluttering signal, leading to Complete Obstruction signals. Thus thegraph shows a complete correlation between movement in an airway passageof an oral cavity and the signal generated by the implantable OSAsensor. The signals shown may be processed or analyzed to be used toalleviate or predict future OSA events.

OSA Implantable Sensor Activated Mandibular Repositioning Device

Medical solutions to OSA include mandibular repositioning devices (MRD).A MRD typically includes at least an upper portion for coupling to theupper jaw, and a lower portion for coupling to the lower jaw. The twoportions lock together to form an unnatural jaw position byrepositioning/advancing the lower jaw. The result is that the base ofthe tongue is also moved forward to prevent it from closing the airway.Prior art MRDs may be effective but are not well-liked by many patients.The unnatural position of the jaw must be assumed throughout a night'ssleep, often for several hours. The unnatural position locks the jaw andcauses pain to the patient. Patients who may otherwise benefit from amandibular repositioning device will abandon treatment because of thediscomfort. Patients using a mandibular repositioning device are forcedto wear the device continuously, regardless of when OSA events occur,and thus may suffer from unnecessary pain and discomfort.

FIG. 56A shows a mandibular repositioning device (MRD), in accordancewith one embodiment of the present invention. The MRD shown in FIG. 56Aoffers a significant improvement over prior art devices. The patient'slower jaw may only move in response to OSA events and thus not be lockedfor an entire night's sleep. Accordingly, a patient using the MRD wouldnot have the discomfort and pain that is associated with prior artdevices that lock the jaw continuously. The patient will accordinglyrealize the benefits of treating OSA and also not suffer from the painthat prior art MRDs imposed.

The MRD includes a fixed upper jaw positioner 400. The fixed upper jawpositioner 400 is configured to mate and align with a portion of theupper palate and/or upper dentures of a patient who suffers from OSA.The fixed upper jaw positioner 400 is typically a custom match to thepatient and may be constructed from a variety of polymers or metals. Thefixed upper jaw positioner 400 is sufficiently constructed such that itwill remain affixed to a portion of the upper palate and/or upperdentures when force is applied in a lateral manner relative to the topbiting surface of the upper dentures.

The MRD also includes a moveable lower jaw positioner 402. The moveablelower jaw positioner 402 is configured to mate and align with at least aportion of the lower dentures of the patient and is similarlyconstructed to the fixed upper jaw positioner 400. The moveable lowerjaw positioner 402 is sufficiently constructed such that it will remainaffixed to the lower dentures when force is applied in a lateral mannerrelative to the top biting surface of the lower dentures.

At least one linkage 404 connects the fixed upper jaw positioner 400 andthe moveable lower jaw positioner 402. In the example shown, twolinkages are included, but only one is required. The linkage 404includes a first end and a second end. The first end is moveablyattached to the fixed upper jaw positioner 400, for example by a pin ora hinge. The second end is likewise connected to the moveable lower jawpositioner 402.

The fixed upper jaw positioner 400 can include at least one jaw actuator406. In the example shown, two jaw actuators 406 are shown, but only oneis required. In one embodiment, the jaw actuator 406 can be anultrasonic linear piezoelectric motor. Rechargeable battery power andelectronics for the actuator are housed within the upper jaw positioner400. The jaw actuator 406 may alternatively be positioned on or aboutthe moveable lower jaw positioner 402 or the linkage 404.

In use, the jaw actuator 406 actuates a moveable rod 408, which islinked to the first end of the linkage 404, to move in the backwardsdirection. The actuation results in a torque which in turn causes thesecond end of the linkage 404 to move the moveable lower jaw positioner402, and thus the patient's lower jaw, in the forward direction. Theresulting movement can alleviate an OSA event. However, non-tonguerelated OSA events may not be alleviated. The jaw actuator 406 may holdthe moveable lower jaw positioner 402 until the OSA event subsides, andthen move the lower jaw positioner 102 back into its original position.

FIG. 56B shows a block diagram of a system which can be configured tocontrol and activate the MRD. The control circuit 410 may determine whenan OSA event occurs and can operate the MRD to alleviate the OSA event.A sensor 412 a is electronically coupled to the control circuit. Sensor412 a senses whether an OSA event occurs. For example the sensor 412 amay detect vibrations in the jaw area which are OSA related. The sensor412 a may be an implantable OSA sensor as described herein. The externalsensor 412 b may transmit a wireless signal to the control circuit toidentify an OSA event. The external sensor 412 b may alternatively beplugged into the implantable OSA sensor by way of a detachable plug.Alternatively, an external sensor 412 b may be electronically coupled tothe control circuit 110. For example, the sensor may measure bloodpressure or oxygen levels which fluctuate according to an OSA event.

The control circuit may also receive instructions from an outsidecontroller, for example as shown in operations 316 and 318 of FIG. 55A.Thus, the MRD device may be the OSA therapy device of operation 318.

The control circuit 410 is configured to instruct the motor control 414to actuate the MRD upon realization of an OSA event. Power 416 can besupplied to the MRD by a rechargeable battery. When the event subsides,the motor control 414 can move the MRD back to its original position.Additionally, the sensor 412 b may be manually configurable to activatethe MRD on command. Thus, the patient, if desired, may wish to be in alocked jaw position continuously or for a programmed amount of time.

An optional recording device 418 may be used in conjunction with thesystem, and wirelessly coupled to the control circuit 410 and sensor412. The recording device may be used to determine efficacy of the MRDin a specific patient, as the MRD may not treat all causes of an OSAevent. Thus in use the recording device 418 can record when an OSA eventoccurs and if the MRD worked to alleviate the OSA event. For example ifan OSA event occurs and the sensor 412 shows that the event subsidedtemporally in conjunction with activation with the MRD, the resultingdata can show the MRD to be effective in that patient. However, if anOSA event occurred and the sensor 412 showed that the event subsidedlong after the activation of the MRD (e.g. self-resolved), the resultingdata could show that the MRD may not have been effective for thatpatient at that particular time and OSA event. This is a significantadvantage over prior art devices which had no means to integrallydetermine efficacy.

An optional timer 420 may also be used in conjunction with the system.The timer 420 can be programmed to activate the MRD after the timercounts down. This is advantageous to avoid unwanted MRD actuations whilethe patient is still awake. Unwanted activations may cause discomfortand prevent the patient from falling asleep. For example the timer 420may be set to allow the control circuit 400 to activate 25 minutes afterbeing worn by the patient. This would ensure that the patient is fullyasleep when the MRD is functioning.

FIG. 56C shows a method of alleviating an OSA event. The methodincorporates the device and systems described herein, for example asshown in FIGS. 56A and 56B. At operation 440 an airway sensor 412 b,such as an implantable OSA sensor, can send a signal to the controlcircuit 410. At operation 442 the control circuit 410 can make adetermination whether an OSA event has occurred. Alternatively theairway sensor 412 b may only send signals if an OSA event has occurred,and the control circuit 410 can make no determination and act to resolvethe OSA event. At operation 444 the MRD can be activated and the lowerjaw can be moved forward to alleviate the OSA event by opening theairway. At operation 446 the airway sensor 412 b can confirm to thecontrol circuit 410 that the OSA event has subsided. At operation 448the control circuit 410 can instruct the motor control 414 to move theMRD to the original position, e.g. jaw in the normal position. Atoperation 450 the MRD can be positioned back to its original position.

OSA Implantable Sensor Auto-Titration of CPAP/BiPAP

A continuous positive airway pressure (CPAP) machine is used mainly bypatients for the treatment of OSA events at home. The CPAP machine stopsan OSA event by delivering a stream of compressed air via a hose to anasal pillow, nose mask or full-face mask, splinting the airway (keepingit open under air pressure) so that unobstructed breathing becomespossible for reducing and/or preventing OSA events.

The CPAP machine blows air at a prescribed pressure (also called thetitrated pressure). The necessary pressure is usually determined by asleep physician after review of a study supervised by a sleep technicianduring an overnight study (polysomnography) in a sleep laboratory. Thetitrated pressure is the pressure of air at which most OSA events havebeen prevented, and it is usually measured in centimetres of water (cmH₂O). The pressure required by most patients with sleep apnea rangesbetween 6 and 14 cm H₂O. A typical CPAP machine can deliver pressuresbetween 4 and 20 cm H₂O. More specialized units can deliver pressures upto 25 or 30 cm H₂O.

APAP or AutoPAP or AutoCPAP (Automatic Positive Airway Pressure)automatically titrates, or tunes, the amount of pressure delivered tothe patient to the minimum required to maintain an unobstructed airwayon a breath-by-breath basis by measuring the resistance in the patient'sbreathing, thereby giving the patient the precise pressure required at agiven moment and avoiding the compromise of fixed pressure. VPAP orBiPAP (Variable/Bilevel Positive Airway Pressure) provides two levels ofpressure: Inspiratory Positive Airway Pressure (IPAP) and a lowerExpiratory Positive Airway Pressure (EPAP) for easier exhalation.

FIG. 57A shows a positive airway pressure (PAP) system 500, which may bea CPAP, APAP, VPAP, or APAP machine, according to one embodiment of theinvention. The PAP system 500 generally includes a control system 502,and a connected inspiration mask 504 which forms a breathing circuit.PAP systems 500 generally include electronic controls, sensors, and anair pump system. PAP systems are known in the art, for example as shownin published Patent Application US 2008/0041383, the entirety of whichis incorporated by reference herein. Prior art PAP systems use pressuresensors to detect OSA events. For example fluctuations or lower orhigher pressure readings than a predetermined norm may indicate to aprior art PAP system that an OSA event has occurred. The PAP system 500,in accordance with one embodiment of the invention, includes animplantable OSA sensor (not shown) wirelessly coupled to the controlsystem 502. The implantable OSA sensor (not shown) is advantageouslyconfigured to work in conjunction, or in lieu of, with a pressure sensor(not shown). Thus the implantable OSA sensor may work with the pressuresensor to generate an optimum pressure point, or optimum input pressure.

FIG. 57B shows a flow chart for use of a PAP system, according to oneembodiment of the invention. At operation 506 an airway sensor candetect an OSA event in a patient. The airway sensor may be animplantable OSA sensor as described herein. The patient is also coupledto a PAP system. The implantable OSA sensor may generate andcontinuously, or intermittently, output a signal to a sensor analyzer.The output signal may be sent from the implantable OSA sensor to thesensor analyzer as a wireless signal. At operation 508 a sensor analyzeranalyzes the output signal of the implantable OSA sensor. The sensoranalyzers may be further electronically based on neural networkalgorithms or adaptive algorithms, and may be based on adaptive,nonlinear, or linear controls. The sensor analyzer can output the signalto the PAP pressure controller at operation 510. In operation 512 aconventional pressure sensor is monitoring air pressure from thepatient. The conventional pressure sensor may also sense other patientinputs, e.g. airway resistance. The conventional pressure sensor alsosends information to the PAP pressure controller in operation 512. ThePAP pressure controller can use the information from the conventionalpressure sensor and the output signal of the sensor analyzer to generatean optimum input pressure, and thus relieve the OSA event. The PAPpressure controller strategy may be based on neural network algorithmsor adaptive algorithms, and may be based on adaptive, nonlinear, orlinear controls. Thus, the PAP system may learn how a particular patientreacts to OSA events and titrate pressure in a faster and morepredictable manner than prior art PAP systems. In an alternativeembodiment the conventional pressure sensor is not present, and the PAPsystem relies on the implantable OSA sensor for signaling OSA events.

It is apparent to one skilled in the art that various changes andmodifications can be made to this disclosure, and equivalents employed,without departing from the spirit and scope of the invention. Elementsshown with any embodiment are exemplary for the specific embodiment andcan be used on other embodiments within this disclosure.

1. A system to treat obstructive sleep apnea, comprising: an ionicpolymer metal composite (IPMC) sensor attached to a region in an airwaypassage in an oral cavity which generates an electrical output when achange in shape of the airway passage in the oral cavity occurs; atransmitter device electrically coupled to the IPMC sensor andconfigured to transmit at least one electronic signal; and anelectronically actuated mandibular repositioning device (MRD) configuredto move a jaw from a first position to a second position based on theleast one electronic signal to treat the sleep apnea event.
 2. Thesystem of claim 1 wherein the IPMC sensor includes an electro activepolymer material.
 3. The system of claim 2 wherein the IPMC sensor isconfigured as an elongated strip.
 4. The system of claim 1 wherein theMRD comprises: a fixed upper jaw positioner configured to align with aportion of an upper denture; at least one linkage with a first end and asecond end, the first end moveably attached to the fixed upper jawpositioner; a moveable jaw positioner configured to align with a portionof a lower denture and moveably attached to the second end of linkage;and at least one jaw actuator attached to at least one of the fixedupper jaw, at least one linkage, and moveable jaw positioner.
 5. Asystem of claim 4 wherein the MRD additionally includes a controlcircuit.
 6. The system of claim 5 wherein the at least one jaw actuatoris controlled by the control circuit.
 7. The system of claim 5 whereinthe control circuit is wirelessly coupled to the transmitter device. 8.The system of claim 5 wherein the control circuit includes a timer. 9.The system of claim 5 wherein the control circuit includes a motorcontrol.
 10. The system of claim 1 wherein the IPMC sensor is integralwith the transmitter device.
 11. The system of claim 1 wherein the atleast one electronic signal is a digital signal.
 12. The system of claim1 wherein the at least one electronic signal is an analog signal.
 13. Amethod to treat sleep apnea, comprising: generating at least oneelectronic signal from an ionic polymer metal composite (IPMC) sensorattached to a region in an airway passage in an oral cavity when achange in shape of the airway passage in the oral cavity occurs from anobstructive sleep apnea event; analyzing the at least one electronicsignal; generating an output based on the at least one electronicsignal; and actuating an electronically actuated mandibularrepositioning device (MRD) configured to move a jaw from a firstposition to a second position based on the output to treat the sleepapnea event.
 14. The method of claim 13 additionally comprisinggenerating at least one additional electronic signal from a second ionicpolymer metal composite (IPMC) sensor.
 15. The method of claim 13wherein the output is generated in a linear, non-linear, or adaptivefashion.
 16. The method of claim 15 wherein the output generation isbased on neural network algorithms.
 17. The method of claim 13 whereingenerating includes converting the at least one additional electronicsignal into a digital signal.
 18. The method of claim 13 wherein the MRDincludes at least one MRD motor, and actuating the electronicallyactuated MRD additionally includes activating the at least one MRD motorto move the jaw from the first position to a second position.
 19. Themethod of claim 13 wherein the at least one electronic signal isgenerated from an electro active polymer material.
 20. The method ofclaim 13 additionally comprising reactuating the MRD to move the jawfrom the second position to the first position when the obstructivesleep apnea event has subsided.
 21. The method of claim 20 wherein theMRD includes at least one MRD motor, and reactuating the MRD includesdeactivating the least one MRD motor.